Provides assistance in the credentialing & privileging processes for the Piedmont Clinic, with special emphases on the Piedmont Heart Institute. Location is in Vinings. Monitors the credentialing & privileging processes through closure of all physician and non-physician provider applications for appointment and reappointment for all commercial insurance plans. Monitors the timeliness and completion of the Medicare and Medicaid application process. Collaborates with Piedmont Clinic, Administration, Chief Medical Officers and other staff in order to expedite the payer credentialing & privileging processes. Maintains medical staff demographic database and practice databases specific to credentialed providers. Tracks individual providers through the credentialing & privileging processes. Verifies with third party commercial payers that providers are appropriately established to bill for professional services in the claims processing system. Must possess detailed knowledge of government and third party insurance plans billing policies and procedures. Must possess full knowledge and training in HIPAA regulations. HS or equivalent and at least four years related experience; or Associate's degree and two years related experience in credentialing/provider relations. Preference will be given to applicants who are certified as a medical staff services professional (CMSC).Excellent oral and written communication and computer skills necessary. Experience with ECHO highly preferred. |
