Reimbursement Specialist - Healthcare jobs in West Virginia

Duration: Full time/Permanent/Onsite

Job Description:

• Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers
• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and UNM Health System criteria
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to CVO Credentialing Manager and entity Medical Staff Affairs for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.

Qualifications:

• High school diploma or GED; at least 5 years of experience directly related to the duties and responsibilities specified
• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
• Ability to communicate effectively both orally and in writing.
• Customer service skills