Job Information
Boston Orthotics & Prosthetics Credentialing Specialist in Stoughton, Massachusetts
About Boston Orthotics & Prosthetics: As a leader in specialized pediatric orthotics, we take great pride in having the industry\'s top clinicians, technicians, and administrative staff, led by an executive team dedicated to advancing the orthotics and prosthetics profession. Position Description: The Contracts and Credentialing Specialist is responsible for the timely enrollment of new payors and on-going maintenance of existing payors. This role requires a desire to develop and follow process, strong attention to detail and excellent communication skills (written and verbal) to convey information to payors and cross functionally within the organization. Core Responsibilities: * Prepare credentialing and re-credentialing applications on behalf of BOP clinics and providers for submission to payor contracting entity. * Accurately perform review of new enrollment files for deficiencies and perform follow up on delinquencies. * Responsible for the on-going maintenance of existing BOP locations/clinics and providers including but not limited to the submission of maintenance update forms, weekly expirables and tracking of licenses, certifications and surety bonds * Research and solve credentialing/re-credentialing delays & issues with contracting entity in a timely manner. * Maintains Provider Enrollments: Prepares BOP clinic and provider applications, staff rosters, re-enrollment, and terminations forms and submits them to 3rd party insurance plans. * Works with Clinics and Providers: Communicates enrollment requirements, completes applications, verifies information, and obtains signatures. * Maintains credentialing, enrollment and web portal access tasks in billing system * Maintains insurance web portal access, adding/removing users as needed. * Maintains Data: Enters and updates clinic and provider information in billing system, and department databases. * Follows Timely Processes: Produces status reports and tracking spreadsheets. * Coordinates with Managers: Clarifies provider start dates, practice locations, specialty areas, privileges, and enrollment status. * Prepares and submits facility/clinic and provider applications to 3rd party insurance plans, Medicaid and Medicare * Ensure that all information meets federal and state guidelines when processing applications. * Keep a facility\'s/clinic and provider accreditation up to date and assist with audits. * Compiles and maintains current and accurate data for all clinics and providers * Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all clinics and providers. * Opens incoming mail and distributes accordingly * Accesses confidential and secure federal, state and private databases as need to complete assignments * Triage billing calls and sends messages to appropriate CBO member for completion. * Posts insurance and patient refunds (via check) into billing system Education/Experience: * Three - five years\' experience in credentialing or healthcare preferred. * Excellent interpersonal skills, including the ability to communicate written and verbally with individuals at all levels in a clear, succinct * Understanding of Medicare and Medicaid reimbursement methodologies and community health reimbursement health care services and contracting methodology. * Knowledge of ICD-10 how E&M coding translates into CPT codes desired. * Results driven, able to self-direct and work independently as well as perform in a team environment. * Ability to multi-task, organized, pay close attention to details and be flexible in a fast-paced organization.