Demant

Credentialing Specialist

Department AudioNet America
Job Locations US-MI-Clinton Twp
Job ID
2021-11177

Overview

AudioNet is a hearing benefits administrator who is driven by care—not unit sales. With an average of 35 years healthcare experience, our executive team is comprised of industry experts who understand both the business and medical aspects of hearing benefits.

 

We are seeking a Credentialing Specialist who will be responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by network.

 

This position is also responsible for maintaining all provider files for network compliance by completing initial and subsequent credentialing and ensuring all credentialing records comply with regulatory and accrediting standards.

Responsibilities

Manage Credentialing /Recredentialing Process

  • Roster providers in CAQH/create SimplePSV spreadsheet for upload to CAQH to begin Verifide process
  • Review and ensure documentation files are completed and accurate for committee review
  • Data entry of providers into CVO software for provider feed pull
  • Maintain W9/Direct Deposit forms for Network Billing

Credentialing Committee Member

  • Assemble completed credentialing packages for Credentialing Committee Review and Build Welcome packages

Data Integrity Reporting

  • Maintain sanctions reporting and expiring documents for providers (State License and Professional Liability Insurance)
  • Pull SanctionsTrack export from CAQH weekly
  • SSDMF monthly monitoring
  • Enroll providers in NPDB Continuous Query / Update CVO to remove termed providers

Provider Communication

  • Maintain and update Provider Credentialing Manual
  • Manage Provider Notices

Accounts Payable & Provider Billing

  • Review / Approve Vendor Invoices
  • Enter all providers and service locations into billing software
  • Assist provider with claim submission through network portal

Open Authorization Reports

  • Work with customer service to identify outstanding open authorizations
  • Work with network liaison to resolve authorization issues related to provider credentialing
  • Work with accounting to identify and resolve pending or denied claims

CMS Compliance

  • Work with IT & Compliance to maintain Provider Data Integrity Reporting
  • Maintain sanctions reporting and expiring documents for providers
  • Process quarterly network audits to meet group specific compliance requirements
  • Complete and review quarterly metric reports

Qualifications

  • Provider credentialing / recredentialing:
    • knowledge of Credentials Verification Organization (CVO) platforms
    • knowledge of TotalMD, CAQH & Aperture a plus
  • Excellent computer skills including Excel, Word, and Internet use
  • Detail oriented with good organizational skills
  • Plans and prioritizes to meet deadlines
  • Excellent customer service skills; communicates clearly and effectively
  • High school diploma or GED; at least 3 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, preferred health care experience and degree.

The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

 

Audionet is part of the Demant Group. Demant is a world-leading hearing healthcare group that  for more than a century has played a vital part in developing  innovative technologies and know-how to help improve  people’s hearing and health. In every aspect, from hearing  devices, hearing implants and diagnostic equipment to  intelligent audio solutions and hearing care all over the world, Demant is active and engaged.

 

The Demant Group operates in a global market with companies  in more than 30 countries, employs more than 14,500 staff  and generates annual revenue of DKK 14 billion (approx. 2.1 billion USD). Our products  are sold in more than 130 countries.

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