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Change Healthcare Credentialing Specialist in Helena, Montana

Credentialing Specialist Overview of Position

The Credentialing Specialist will complete/submit all necessary documents/applications to credential providers with respective insurance carriers and national entities; including, but not limited to CAQH and NPI Registry. They will maintain current credentialing processes for all insurance carriers. They will complete routine review of carrier policies and forms to ensure current and update documents are being utilized; frequency determined by insurance or national entity.

What will be my duties and responsibilities in this job?

  • Enter and maintain system profiles/databases used for storing provider billing numbers

  • Written and/or verbal follow-up of outstanding credentialing requests with client and/or insurances carriers

  • Research/resolve accounts appearing on A/R reports related to credentialing matters, including pre/post billing edits

  • Assists in identifying current/potential credentialing issues specific to outstanding receivable

  • May participate in trainings/meetings with Payers, internal departments, offshore partners, Client contact(s) and TES Management, etc. to address trends in denials or unprocessed claims

  • Presenting data to appropriate parties and partnering to develop resolutions

  • Participates in daily production assignments that will continue to develop understanding and knowledge of processing guidelines and expectations of respective client(s) payer mix

  • Assist in credentialing training/quality review process of domestic/offshore partners

  • Training and Quality Assurance of other team members or the provider practice as needed.

  • Assist in other duties as assigned

What are the requirements needed for this position?

  • High School Diploma or equivalent

  • 2-3 years of additional schooling/related work experience

  • Must be computer literate

  • Intermediate working knowledge of MS Excel, MS Word and MS Outlook, and Adobe

What other skills/experience would be helpful to have?

  • 1 year of A/R follow up or previous credentialing experience preferred

  • Strong written and oral communication skills

  • Strong customer service experience

  • Must maintain patient/client confidentiality

  • Working knowledge of various insurance credentialing requirements by provider type and specialty

  • Ability to work independently with minimal supervision; drives execution

  • Can marshal resources to complete tasks and orchestrate multiple activities to accomplish goals

  • Ability to solve difficult problems in a timely manner with efficient resolutions

  • Ability to work with and communicate with individuals of varying disciplines.

  • Represents the office/Organization in a positive manner; supports and encourages strong morale and spirit in his/her team; works well with others

  • Can negotiate skillfully in tough situations; can win consensus without damaging relationships

What are the working conditions and physical requirements of this job?

  • Employee is regularly required to sit, use hands to finger, handle, or feel objects, tools, or controls and talk or hear. Employee must occasionally lift and/or move up to 25 pounds

    Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Mandate

As a federal contractor, Change Healthcare is adhering to the Executive Order which mandates vaccination. As such, we are requiring all U.S. new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.

As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Change Healthcare. All accommodation requests will be carefully considered but are not guaranteed to be approved.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

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