Top 1 Credentialing specialist Jobs in Madison Wi

Revenue Cycle Credentialing Specialist
Abbott Laboratories —Madison, WI
- $61,300 - $122,700 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
1d

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Revenue Cycle Credentialing Specialist
Abbott Laboratories —Madison, WI
Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
$61,300 - $122,700 a year
1d
Healthcare Credentialing and Medical Staff Administrator
Group Health Cooperative of South Central Wisconsin —Madison, WI
Bachelor’s degree from an accredited college or university in business, health care administration or relevant field is required, or equivalent combination of…
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Must possess a valid National Association Medical Staff Services (NAMSS) Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified…

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Revenue Cycle Credentialing Specialist

Abbott Laboratories -
Madison, WI

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Job Details

Full-time
$61,300 - $122,700 a year
1 day ago

Qualifications

Microsoft Excel
Microsoft Outlook
Contract management experience in healthcare
Government contract management experience
Contracts
Contract negotiation
Healthcare reimbursement methods

Full Job Description

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries.

Position Overview
The Revenue Cycle Contract Credentialing Specialist will facilitate contract implementation by being proactive and reactive, with internal and external parties to ensure the public and private payer contract paperwork and credentialing is in alignment with corporate goals, contracts, and/or regulations. This role is responsible for facilitating and managing the credentialing of contracts for both government and commercial contracts, working closely with market access and the legal contracting teams in developing and maintaining agreements that provide medical providers and patients with access to our assays while aligning with Abbott Cancer Diagnostic's goals and objectives.

This position is field based.

Essential Duties
Include, but are not limited to, the following:

Prepare and maintain credentialing files and reports for all payors and government entities.
Expand both government and commercial payor profiles to include all lines of business units due to mergers and acquisitions; complete updates required by contracts for credentialing, disclosure, and demographic information.
Process and file applications with third party payors according to each payor’s individual requirements and addresses discrepancies, as requested, by payors.
Conduct all follow up steps until payor approval, completion, and acceptance is obtained.
Update NPI records according to provider specifications.
Enroll provider in Medicare/Medicaid as prescribed by each program's requirements.
Track licensure, accreditation, and insurance certificate expiration dates to ensure timely processing to be compliant with mandates for contractual agreements with state and federal regulations with payors.
Complete requests for re-credentialing for payors, commercial, and government entities.
Accept and process all requests from payers for credentialing information, updates, and new contracts and assays.
Answer questions, inquiries, and process requests from all internal and external stakeholders related to credentialing information.
Enroll all business units in Medicare/Medicaid programs.
Address enrollment deficiencies and payor issues regarding commercial and government entities.
Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing.
Serve as liaison between parent subsidiaries, third party billing agents, payors, commercial, Government entities, and all stakeholders to ensure revenue/reimbursement pull through.
Maintain historical data and files.
Interface with multiple departments to provide updates and stay abreast of current initiatives that could affect credentialing and enrollment.
Monitor incoming emails for Odxclaimsupport, Payor Credentialing, GovTeam, ManagedCareContracts, Contact ManagedCare, and CommercialOpsFax.
Effective communication skills, both written and oral, across internal and external stakeholders.
Promote an open, collaborative environment built on trust to foster positive teamwork.
Apply strong attention to detail, organizational, and analytical skills.
Ability to prioritize and manage several projects at once and drive to results with a high emphasis on quality.
Ability to influence without authority.
Ability to identify and implement enhancement opportunities.
Ability to integrate and apply feedback in a professional manner.
Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
Support and comply with the company’s Quality Management System policies and procedures.
Regular and reliable attendance.
Ability to act with an inclusion mindset and model these behaviors for the organization.
Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
Ability to work on a computer and phone simultaneously.

Minimum Qualifications

Associates degree in healthcare administration, public health, business administration, or related field; or high school degree/general education diploma and 2 years of relevant experience in lieu of Associates degree.
1+ years of contracting experience within the healthcare industry.
Demonstrated knowledge of public and private Managed Care payers and reimbursement processes.
Demonstrated understanding of market-related issues, contract development, negotiation, and pull through, as well as the legal and regulatory implications associated with private and government payer contracting.
Basic knowledge of Microsoft Office; including Word, Excel, Access, Outlook, and PowerPoint.
Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
Authorization to work in the United States without sponsorship.

Preferred Qualifications

3+ years of contracting experience within the healthcare industry.

The base pay for this position is $61,300.00 – $122,700.00. In specific locations, the pay range may vary from the range posted.

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