CREDENTIALING SPECIALIST - Limitless Male

  
JOB TITLE: CREDENTIALING Specialist
EMPLOYER: Limitless Male Medical
DEPARTMENT: Revenue Cycle
REPORTS TO: Revenue Cycle Manager

Why Limitless Male Medical Clinic?

Limitless Male is a fast-growing, unique, and team-oriented company that loves to take care of our employees AND our patients. If you are looking to be surrounded by excellence, to be inspired by your peers, to help make a difference, and laughing the whole time… then we need to talk! We also pride ourselves in offering many benefits including health insurance, Limitless Male branded clothing, discounts, a great culture, and more! This is a place you can come in and help men of all walks of life achieve their goals and simply be the best version of themselves.

About the Organization

What is Limitless Male? We are a men’s health clinic where every day, we open the doors to invite men of all ages to change their lives and get back in the game by becoming better husbands, fathers, and co-workers. We do it through various avenues of testosterone replacement, peptides, wave therapies, and many other ancillary products to help men feel their best!

SUMMARY:
The Credentialing Specialist is responsible for credentialing each provider with the necessary facilities and clinics as well as enrolling them in payers to ensure compliance with state, federal, and payer regulations. Each provider providing care at an LMMC clinic or affiliate must be appropriately credentialed for the best possible financial outcome for both the patient and the organization.

DUTIES & RESPONSIBILITIES:

• Collect and verify all pertinent provider information necessary to complete the credentialing and enrollment applications
• Communicate with HR, Operations, and the Revenue Cycle team when a new provider is starting, and their enrollments/credentialing are complete to ensure on-time starts
• Escalate any issues in completing enrollments/credentialing directly to the leader following the LMMC enrollment escalation SOP.
•  Connect directly with providers to build a lasting relationship and ensure compliance with all state, federal, and payer guidelines for credentialing and enrollment  
• Complete enrollment and re-enrollments for each clinic with all contracted payers as required by payer guidelines
• Track and monitor all payer enrollments and re-enrollments for providers and clinic locations using assigned monitoring tool
• Demonstrate solid judgment and discretion working with confidential information
• Comply with all department and company guidelines including all applicable laws and regulations.
• Work with teams inside and outside the department, and external customers as needed to ensure best-in-class revenue cycle operation.
• Maintain strong knowledge of payer, state, and federal regulations as it relates to the processing enrollment and credentialing files

OTHER JOB DUTIES

• As assigned by the revenue cycle manager

QUALIFICATIONS

• ON SITE (OMAHA) MONDAY-FRIDAY
• 2-3 years experience in professional fee revenue cycle, previous enrollment or med staff experience a plus
• Solid working knowledge of enrollment guidelines by payer
• Solid working knowledge of credentialing to ensure compliance with state and federal requirements
• Proficient with Microsoft Office applications
• Ability to multitask, prioritize workload, and meet deadlines
• Excellent verbal and written communication skills
• Detail oriented
• Ability to work in a fast-paced environment
• Strong customer service skills
• Ability to answer patient and insurance company questions
• Ability to work independently and in a team environment
• Strong problem-solving skills
• Results-oriented

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