CREDENTIALING SPECIALIST (WFH)
Company: Rotech Healthcare
Location: Orlando
Posted on: September 30, 2024
Job Description:
About RotechRotech Healthcare Inc. is a national leader in
providing ventilators, oxygen, sleep apnea treatment, wound care
solutions, diabetic solutions and home medical equipment. We help
patients lead a more comfortable and productive life by keeping
them engaged in their care and empowering them to manage their
health and treatment at home. Rotech provides high quality medical
products, services and outstanding customer care through hundreds
of locations across 45 states. For additional information, visit
our company homepage Rotech.comOverview and ResponsibilitiesJob
Summary We are seeking a dedicated Credentialing Specialist to join
our team. In this position, you are responsible for the complete
credentialing process as defined by payer credentialing policies
and procedures including provider manuals, contract language and
requirements to ensure Rotech compliance and contract performance
standards are met for all Rotech Locations. Position
responsibilities also include, re-credentialing, submission of COIs
and licensure expirations, LANs, provider acquisition reporting and
ensuring Rotech's compliancy with the No Surprise Act.
- Work From Home after successful completion of IN OFFICE
TRAINING and are meeting expectations with management approval
Essential Job Duties and Responsibilities (Reasonable
accommodations may be made to enable individuals with disabilities
to perform these essential functions. Please note this job
description is not designed to cover or contain a comprehensive
listing of activities, duties or responsibilities that are required
of the employee for this job. Duties, responsibilities and
activities may change at any time with or without notice.)
- Administration of contracts includes but not limited to a
complete review of payer contract language, policies and
procedures, provider manuals, billing rules and guidelines
- Analyzes monthly trend reports (Held Item, Adjustment Analysis)
to identify additional research and/or updates required to
Contract/ Item Master
- Assigns and updates necessary contract classifications for
Managed Care/Government Reporting purposes
- Assist with projects at BCC when access to older billing rules,
HCPCs, ICD9, etc. is required to process claims in arrears (monitor
window of claims processing to ensure no inaccurate billing occurs
during project time frame)
- Assists in creating and maintaining Rotech's Supplier Diversity
Database including yearly mailing to all Rotech vendors
- Communicates with Purchasing on appropriate base contract
pricing- Contract
- Communicates with the Billing Center, Central Intake, Sleep
Central and Locations regarding contract changes and/or updates
including distribution of reference guides as required
- Completes payer credentialing and re-credentialing applications
via hard copy, email, fax or online based on payer
specifications
- Conducts conference calls with payors as required
- Conducts Contact implementations with appropriate departments
as well as payer in-services as required
- Conducts/leads calls with payers regarding changes and/or
updates to payer rules, processes, guidelines, pricing
methodologies and credentialing practices
- Creates and maintains job aids and training materials as it
relates to contract and credentialing functions and systems used
within CAD
- Creates FOIA requests as appropriate
- Files yearly government reports such as Subcontracting report,
CCR registration, Vets-100
- Maintains Contract Quick Reference Guides on the Rotech Home
Page
- Maintains current Location database spreadsheet and COIs
- Maintains database of contracts within shared drive, e-Intake
and Contract Logix
- Maintains database of credentialing/re-credentialing within
Laser Fiche and shared drive
- Maintains Location Dashboard information so assigned contracts
appear on appropriately contracted locations
- Maintains monthly LANs updates and appropriate payer
notification
- Maintains pricing and other updates within the online ordering
system as required
- Maintains timely filing requirements outlined in Contracts to
ensure claims drop as required by Contracted Payers into the timely
filing cue within the billing center
- Maintenance and administration of all Contracts Rotech provides
service for including but not limited to Managed Care, Government,
Hospice, Skilled Nursing, Non-Participating or Out of Network,
Professional Service Agreements and Patient Pay Contracts
- Monitors the release of solicitations daily and maintains a
list of active solicitations within company database
- Obtains and updates all Medicare and Medicare Non-Assigned
Contracts as new HCPCS, Pricing, Modifiers, Certification
requirements are published and available (researching websites,
payor payment boards, government websites, etc.)
- Obtains, researches, and updates each State's Medicaid
Contract, HCPCS, Pricing, Modifiers and Certification requirements
as published on various state websites, government payment boards,
etc.
- Performs maintenance and administration of HCPCS and ICD-9
codes as updated, changed or published by Medicare to ensure
appropriate HCPCS and ICD9 are available for predetermined
effective date and claims processing
- Receives, researches, and validates payer claims addresses and
designates applicable billing requirements that will print on all
Rotech paper claim forms. Maintains all updates or changes to these
requirements as submitted by locations, BCC's, and/or payers
- Research and applies internal company rules and policies to all
items set-up on contracts, Sales Commission Points, Assignment of
Benefits Requirements, Coverage type for Rent to Cap items, product
category, product class inventory track able items, eintake
viewable items, eintake product kit set ups and manufacturer
requirements
- Research of competitor information
- Researches and verifies contract requirements through various
sources (billing/payment history, payor provider support, etc.)
when there are no contracted requirements on file
- Updates all Private Insurance Contracts that are on schedule
with Medicare HCPCS, Pricing, Modifier and Certification updates
(as provided on payor profile, through contracting department, or
payor payment boards/websites, etc.)
- Performs other duties as assigned
QualificationsEmployment is contingent on
- Background investigation (company-wide)
- Drug screen (when applicable for the position)
- Valid driver's license in state of residence with a clean
driving record (when applicable for the position) Required
Education and/or Experience
- High school diploma or GED equivalent, required
- Knowledge of Healthcare Contract Language and the ability to
read and interpret Contract/Credentialing requirements and
guidelines
- Five years directly related experience in the medical industry
working with HCPCS, CPT and ICD-9 Codes Preferred Education and/or
Experience
- Paralegal Certificate, preferred
- Bachelor's Degree or equivalent combination of college
education and/or related work experience in healthcare, billing,
and/or industry contracts, preferred
- Lead/Supervisory experience Skills and Competencies
- Ability to identify and resolve potential financial risk
items/situations
- Ability to solve practical problems and deal with a variety of
concrete variables in situations where only limited standardization
exists
- Ability to think critically and analytically
- Effectively communicate in English; both oral and written
- Interpret a variety of communications (verbal, non-verbal,
written, listening and visual)
- Knowledge of Industry Contracts and medical billing
- Maintain confidentiality, discretion and caution when handling
sensitive information
- Multi-task along with attention to detail
- Self-motivation, organized, time-management and deductive
problem solving skills
- Work independently and as part of a team Machines, Equipment
and Technical Abilities
- Email transmission and communication
- Internet navigation and research
- Microsoft applications; Outlook, Word and Excel
- Innovative Medical Billing System (IMBS) preferred
- Office equipment; fax machine, copier, printer, phone and
computer and/or tablet Physical Demands
- Lift and carry office equipment at times
- Requires sitting, walking, standing, talking and listening
- Requires close vision to small print on computer and/or tablet
and paperwork
Rotech InformationBenefits
- 401k
- Medical, Dental and Vision
- Life Insurance and Disability
- Generous Paid Time Off and Paid Holidays
- Employee Discount Program
- Employee Recognition Program
- Bonus and Incentive Opportunities
- Mileage reimbursement (when applicable for the position)
- Telephone reimbursement (when applicable for the position) Make
the Right Move and Submit your Resume Today! The hiring manager
reviews resumes and contacts applicants that have related
experience to the applied position. To view the status of a
position that you submitted your profile to, Sign into your
account. All positions are posted for a min of 5 days and positions
are opened until filled with a qualified applicant, generally no
greater than 200 days. We appreciate your interest in Rotech
Healthcare Inc. Equal Opportunity Employer of Minorities, Females,
Protected Veterans and Individuals with Disabilities. Rotech
Healthcare Inc. recruits, employs, trains, promotes, transfers,
separates from employment and compensates employees without regard
to membership in, association with, or perception of race, color,
age, gender, gender identity, religion, creed, national origin,
ancestry, citizenship, marital status, veteran status, sexual
orientation, physical or mental disability, pregnancy or any other
personal characteristic protected by applicable federal, state and
local laws governing nondiscrimination in employment in each
locality where Rotech has employees.
Keywords: Rotech Healthcare, Land O' Lakes , CREDENTIALING SPECIALIST (WFH), Other , Orlando, Florida
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