Credentialing Specialist (WFH) Position Available In Orange, Florida

Credentialing Specialist (WFH) Orlando, Florida Contracts/Purchasing 24498
Job Description
About Rotech Rotech 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 Overview and Responsibilities Job 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 pliance 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. 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 ence 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 Qualifications Employment is contingent on ground 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 Information Benefits Generous paid time Off and paid holidays
Overtime pay for non-exempt hourly positions based on business needs
Commission for Account Executives
Fixed and variable rate car reimbursement for Area Managers and Account Executives
Employee discount program
Employee recognition program
Bonus and incentive opportunities Mileage reimbursement (when applicable for the position)
Telephone reimbursement (when applicable for the position)
EAP
401k
Medical, Prescription, Dental and Vision
HSA and FSA/Dependent Care FSA
Life Insurance, Disability, Accidental death, Identity protection and Legal services
Meru Health Mental health and Mercer SmartConnect Medicare programs
Livongo Diabetes and High Blood Pressure programs
Healthcare Bluebook and RX Savings solutions programs
HEPB and TB vaccinations 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.