Credentialing Supervisor - Mesa in Mesa, AZ at NextCare Urgent Care

Date Posted: 2/12/2021

Job Snapshot

  • Employee Type:
  • Location:
    Mesa, AZ
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Credentialing Supervisor 

The Credentialing Supervisor will oversee the processes of ensuring all providers are tied to our contracts and entities to ensure correct credentialing and billing. They will supervise the credentialing representatives and ensure consistency of team efforts and we are compliant with all state and federal guidelines.

Job Requirements

Representative Functions:

  • Perform Primary Source verification on all providers.
  • Complete and submit credentialing applications for both providers and facilities.
  • Maintain files with provider and facility credentials.
  • Obtain and supply information to correctly bill services.
  • Track information and submit timely.
  • Update Primary Source Application every two years.
  • Completing any re-credentialing application on the providers.
  • Completing and submitting group applications for any new locations or credentialing applications.
  • Submitting notification letters to plans for new locations or any updates to facilities.
  • Assist other members of team as needed.
  • Initiate and maintain CAQH files on all Provider’s

Supervisor Functions:

  • Coordinate provider & clinic credentialing for all facility acquisitions and new build clinics in East and West regions. Assist in credentialing of new or existing providers.
  • Organize and lead the weekly regional meetings by being the point person and report on credentialing status for various states and contracts
  • Verify all pertinent identifying information and report any discrepancies that are found
  • Research government and state requirements for credentialing in new locations and states
  • Check with plans on a quarterly basis to make sure that the credentialing process has not changed for each insurance and check to insure we are using the current forms and applications for these insurances
    Coordinate with contracting, licensing, regulatory, and other departments as necessary
  • Maintain the Contracting spread sheets used by departments to keep track of required information needed to process Contracts from start to finish and add any additional information as needed
  • Oversee company credentialing representatives to insure the Credentialing is flowing in a smooth and timely fashion
  • Identify any areas there are issues with timely credentialing and develop a process to streamline the functions to keep on track to Credentialing timelines.
  • Maintain companywide processes, standards, and procedures as listed under the essential functions
  • Assist Billing Office Systems Support with tracking billing dates and holds on spreadsheets and updating as needed so claims can be released timely
  • Assist with gathering billing information needed for new contracts including copies of cards, billing address, special billing instructions, contact reps, etc.
  • Complete special projects as assigned by management
  • Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
  • Performs other related duties as assigned or described in Company policy.

Education: High School diploma or equivalent

Experience: This position requires the ability to get along with providers, insurance representatives, human resources, and management in a respectful and professional manner. General computer skills required including experience using Access, Word and Excel. Applicant must have at least two years prior credentialing experience and knowledge of various Commercial, Government and Work Comp. insurance company credentialing procedures for multiple states. Position requires medical billing knowledge and understanding of claims flow and requirements for credentialed providers. Position requires organizational skills and the ability to accurately track several different areas of billing, credentialing and contracting information.