Aspen Dental Credentialing Specialist in East Syracuse, New York
WellNow Urgent Care℠ is here to help our patients get well. Founded as Five Star Urgent Care in 2011 by Dr. John Radford, we rebranded as WellNow Urgent Care in 2018 to better reflect our mission of offering the care you need with the convenience you crave for all non-life-threatening injuries and illnesses. With new center openings, and the acquisitions of MASH and Hometown Urgent Care, our footprint has grown to 85+locations throughout New York, Ohio, Illinois, and Michigan. Our growth-focused model positions us as one of the fastest-growing providers of quality urgent, virtual, and occupational care – contributing to our Urgent Care Association accreditation, a designation earned by just 10% of urgent care facilities. To keep our promise of being healthcare at its most convenient, our centers are open daily for walk-ins or check-ins as early as 7 am until as late as 11pm, with 24/7 virtual care. Join our team of remarkable providers, be trained to accurately diagnose and treat a wide range of ailments, and play an integral role in encouraging our PULSE values.
As reflection or our continued growth we have an opportunity to join our team as a Credentialing Specialist, this role will be remote, but will need to be commuting distance from either our Ellicottsville or East Syracuse office.
Updates provider file in practice management billing system upon receipt of participation data.
Monitors provider files making sure all pertinent data is current and active such as DEA license, State Medical License, insurance contracts and hospital privileges.
Manages all provider credentialing and re-credentialing activities of the practice network in a manner that mitigates the risk of financial losses to the network. Coordinates efforts with Operational leaders through the on boarding process.
Obtains appropriate documents from various resources to complete payer applications. Completes accurately all applications for payer credentialing and re-credentialing in a timely manner.
Maintains monthly update of physician participation list.
Supports the development of payer contract negotiation strategies and support the analytical needs of the organization.
Facilitates the loading and input of all new and revised payer contract terms within Revenue Cycle Management Practice Management System and ensuring accurate interpretation and operational compliance with payer rules.
Develops contract utilization and monitoring criteria to provide the Five Star leadership & administrators with information pertaining to contracts and policies and procedures for operationally administering contract rules.
Assists with denial trends associated with payer related issues and ensures that underpayments are minimal and issues are escalated as necessary through the payer for resolution.
Develops and maintains excellent and productive working relationships with physicians, administrative leaders, and provider relations management at pertinent health plans, insurance companies and state and local government contacts pertaining to payer and plan issues.
Supports the leadership and their meetings by developing payer data and recommendations for change based on collecting the payer communication tools/websites/newsletters to ensure increased payer compliance.
High school diploma is required
2+ years of demonstrable use of MS Office products (Word, Outlook, Excel, PowerPoint) is required
Experience with credentialing is a plus
All qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status.
Street: 281 Sanders Creek
External Company URL: https://wellnow.com/