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McLaren Health Care Insurance Credentialing Specialist in Flint, Michigan

Description

This position reports to the Director of Insurance Credentialing. Responsible for maintaining and updating the initial credentialing and/or re-credentialing of facilities with third party payers and institutional enrollment requirements for governmental programs for the McLaren Health Care system excluding Medicare. Works in collaboration with each facility (subsidiary) to obtain supporting documentation and information required to meet payers regulatory and compliance requirements for their credentialing and enrollment programs. Facilitates and assists with applicable payers relative to changes of information for facility credentialing and enrollment.

  • Prepare, maintain, and respond to third party payer requests for initial credentialing and re-credentialing of facilities (hospitals, behavioral health services, rural health centers, urgent care center, etc.)

  • Obtains, maintains, and monitors re-credentialing due dates for each facility.

  • Acts in the capacity of a facilitator and coordinator with facilities to ensure supporting documentations obtained for initial and re-credentialing payer requirements.

  • Researches and keeps abreast of third party and governmental payers regulations and changes pertaining to credentialing and enrollment.

  • Collaborate with McLaren Physician Partners, McLaren’s PHO, related to requests for credentialing applications, contracted health plan inquiries, assistance on information requests, etc.

  • Obtains and maintains Single Sign On (SSO) for CHAMPS, Medicaid enrollment system, to complete Medicaid enrollment and updates as needed.

  • Respond to Medicaid revalidation requests for facilities:

  • Bi-annually reviews CHAMPs for Medicaid revalidation due dates.

  • Effectively communicates with Director relative to status of projects, facility enrollment, etc including barriers encountering so resources can be allocated.

  • Effectively communicate with appropriate McLaren Health Care system divisions relative to facility enrollment and credentialing.

  • Coordinates with department provider credentialing specialists as needed to facilitate payer updates which impact both professional and facility billing, credentialing, and enrollment.

  • Department lead on questions pertaining to contracted health plan including maintenance of previously researched inquiries.

  • Support McLaren Health Care system vendor for out of state (OOS) Medicaid claims thru the completion OOS Medicaid applications, collecting supporting documentation, and obtaining required signatures.

  • Develops and maintains policies and procedures related to facility credentialing and enrollment. Participates in quality assessment and continuous quality improvement activities as directed through identification of quality improvement opportunities, collection and evaluation of data, and implementation of action plans.

  • Other duties as assigned.

Qualifications

Required:

  • Bachelor degree in health care administration, finance, accounting or related field.

  • Equivalent combination of education and experience may be acceptable.

  • Three years experience in a progressively more responsible role related to health care administration pertaining to institutional enrollment, and/or finance role with reimbursement responsibilities.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Job: Non-Health Professional

Primary Location: Michigan-Flint-Corporate Srvcs Building-MMG

Organization MMG00-McLaren Medical Group - Admin

Employee Status Regular

Shift Day Job

Job Type Standard

Schedule Per Diem

Req ID: 21001015

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