Integrated Medical Services (IMS) is a physician-led organization united through its providers’ commitment to high-quality, innovative health care. The multi-specialty group has primary care and most specialties well represented throughout the Phoenix metropolitan area and many rural locations.
IMS is seeking a detail oriented Credentialing Specialist to join our team. The Credentialing Specialist is responsible for performing and maintaining timely, accurate and complete third party payor credentialing and hospital privileging for assigned IMS providers. In this capacity, this individual ensures accurate, timely and complete submission of third party payor credentialing/recredentialing and hospital privileging information/applications to external designees for the physicians and allied health professionals within IMS.
Essential Job Functions:
- Perform all activities related to credentialing, re-credentialing and monitoring IMS physicians and allied health practitioners. Credentialing includes, but is not limited to, the timely processing of all paperwork and applications necessary to obtain hospital privileges and participation on all necessary insurance plans for practitioners who practice under IMS, Inc. whether contracts are held by IMS, individual practices, or individual providers.
- In conjunction with Brokers, completes activities related to malpractice insurance for all IMS providers.
- Provide timely notifications to IMS or individually held contracted insurance plans, including but not limited to, adding/deleting new providers, adding/deleting practice locations and any other pertinent information to be supplied to insurance plans, etc.
- Process timely initial and reappointments to the medical staff at provided identified and requested hospitals, surgi-centers, etc. This includes the obtainment, organization and submission of all necessary paperwork, documents, etc. such as is needed to fulfill the requirements for hospital or free standing facility privileging at the various organizations.
- Gather, collate, copy and ensure filing of relevant documents needed to maintain all IMS provider files in a “current” status.
- Submit relevant copies of documents to hospitals and insurance plans to meet requirements in keeping their IMS provider files “current.”
Actively participate in departmental meetings, payor meetings, and with departmental process and procedure development and modifications.
Participate as directed in annual location site reviews.
- Use technology to maximize process work efficiencies and effectiveness.
Education and Certification:
- High school diploma or GED required.
- AA degree preferred.
- CPCS license preferred.
5-7 years minimum experience required, specifically medical office and physician and hospital credentialing, 1-3 years minimum experience required, specifically medical office/physician billing and insurance claim follow-up and denial management
- Knowledge of the health plan websites, CAQH, Intelli App software program, GACCP, licensing boards, NPPS (NPI), Medicare (PECOS), National Provider DB and hospital CVO's required
*IMS is a tobacco-free workplace.
Job Status: Full Time
Job Reference #: 19