Credentialing Specialist

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for a nationwide group of audiology services providers. Facilitates all aspects of credentialing, including initial credentialing, re-credentialing and expirable process. Ensures interpretation and compliance with the accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and regulations relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Credentialing Manager.

By understanding and anticipating needs, questions and concerns, the Provider Engagement Specialist creates an effortless experience, making it easier to do business with SH. Training and educating providers every step of the way, whether electronically, over the phone or face to face, this individual will enable our providers to make informed decisions to maximize patient benefits, satisfaction, and outcomes.

Starkey is a world leader in the manufacturing and distribution of advanced hearing technologies. We are in the business of connecting people and changing lives. Our teams come to work each day focused on ensuring people everywhere have the products and services they need to hear better and live better.

Founded in 1967 by Bill Austin, Starkey is known for our cutting-edge hearing health innovations, industry-leading research and development, and not being afraid to push the edge of what's possible.

We are headquartered in Eden Prairie, Minnesota, have over 5,000 employees in 29 facilities across the globe, and do business in more than 100 markets worldwide.

Watch this video to see more of what sets Starkey apart.

https://youtu.be/9cUYwTlCepg?si=wkovx8_R_iINfrc6

JOB SUMMARY DESCRIPTION

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for a nationwide group of audiology services providers. Facilitates all aspects of credentialing, including initial credentialing, re-credentialing and expirable process. Ensures interpretation and compliance with the accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and regulations relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Credentialing Manager.

JOB RESPONSIBILITIES

• Coordinate, and monitors the review and analysis of provider applications and accompanying documents, ensuring provider eligibility.
• Conduct thorough research and primary source verification using on-line tools and phone calls of all components of the application
• Identify issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow
• Prepares credentials file for completion and presentation to Credentialing Committees, ensuring file completion within time periods specified.
• Process requests for application and payer credentialing
• Respond to inquiries from healthcare insurance payers, interfaces with internal and external customers on day-to-day credentialing.
• Utilize the credentialing database, optimizing efficiency, and performs query, report, and document generation
• Monitor the initial, reappointment and expirable process for all providers, ensuring compliance with department policies and procedures.
• Maintain relationship with Insurance payer to obtain correct credentialing process.
• Update and send monthly database/roster to payer
• Develop processes and reporting tools with TPA payer.
• Maintain credentialing/contracting folders in SharePoint to secure true information
• Maintain CAQH profile for each provider
• Perform miscellaneous job-related other duties as assigned.
• Other duties/responsibilities as assigned

JOB REQUIREMENTS

Minimum Education, Certification and Experience Requirements

• Education (i.e. 4-year college degree, license, certification)
  
  
  
  • Associate degree in Health Care or Business Administration preferred
  • High School diploma or equivalent required
  
  
  
  
• Experience (i.e. years of work experience related to the job)
  
  
  
  • 4 years working in a managed care or medical office environment is required.
  
  
  
  

Knowledge / Technical Requirements

• Understanding of certification requirements.
• Basic understanding of NPI maintenance, Medicare, and Medicaid programs, CAQH, etc.
• Knowledge of medical credentialing standards.

Competencies, Skills & Abilities

• Ability to communicate effectively and professionally, both orally and in writing, with all levels of internal and external customers.
• Program planning and implementation skills to increase efficiencies and productivity.
• High degree of accuracy and attention to detail.
• Informational research skills, using on-line content, telephone conversations, and printed materials.
• Ability to use independent judgment to manage and impart confidential, HIPAA-protected information.
• Ability to make administrative/procedural decisions and judgments.

Salary and Other Compensation:

The target pay range for this position is between $40,000-$45,000/ year. Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.

This position is eligible for a bonus based upon performance results. There is no guarantee of payout.

Benefits:

The following benefits for this position, subject to applicable eligibility requirements, include medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, short-term disability insurance, long-term disability insurance, employee assistance program, hearing aid benefits, PTO, paid holidays annually, floater days annually, volunteer service day annually, paid paternity leave, and tuition reimbursement. This position is eligible for a bonus based upon performance results. There is no guarantee of payout.

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