Kaiser Permanente Specialist, Credentialing Medicare & Medicaid - Atlanta in Atlanta, Georgia
Responsible for obtaining, tracking, and coordinating required credentialing, re-credentialing, and enrollment information, as applicable, for Medical Doctors (MD), Nurse Practitioners (NP), Physician Assistants (PA), and other specialties as applicable to Medicaid & Medicare participation. Responsible for submitting and maintaining enrollment, status, documentation, and information needed, as well submission of credentialing providers to organizations, agencies, affiliates, and third party payers. Serves as a role model and demonstrates the company's core values of respect, honesty, integrity, diversity, and community relations.
Essential Responsibilities: - Serve as Kaiser Permanente representative and point of contact overseeing the enrollment process for all credentialed providers, facilities, and entities for the Georgia Department of Community Health Medical Assistance Plans Division for Medicaid and PeachCare for Kids, Including coordinating entities Hewlett-Packard Enterprise Services (HPES), Centers for Medicare & Medicaid Services (CMS), and Cahaba Government Benefits Administrators. Ensures all enrollment and revalidation applications meet the applicable criteria and are processed in a timely, efficient, and thorough manner in accordance with all polices, procedure, and agreements. Monitors the providers Medicaid and Medicare status to ensure support, minimizing denied claims and good standing with partnerships and afflicted organizations - Enrolls all new providers in Georgia Medicaid using the GA Medicare and Medicaid Information System (MMIS). Completes online applications, establishes provider username and login credentials for record. - Enrolls all new providers in Medicare using the Provider Enrollment, Chain and Ownership System (PECOS). Completes online applications, establishes provider username and login credentials for record. - Identifies and analyzes the enrollment process for continuous improvement opportunities that support the overall goals of the department, including conducting audits as required of applications, turnaround time, accuracy, etc. - Acts as the point of contact for questions related to enrollment verifications, assisting Accounts Receivable, Accounts Payable, Medicaid Relations Coordinator, and various department in resolving any billing issues as it relates to Medicaid and Medicare provider status and assigned numbers. - Monitor and maintain accurate reporting for provider enrollment database (MPID) and supporting spreadsheets by identifying, investigating, reporting, tracking, and follows-up on any potentially adverse information received or changes. - Work closely with Regional Recruitment department, enrolling all new applicable providers in Medicaid. Assist with revalidations for Medicare providers. Communicate on a weekly basis to ensure all paperwork and duties are complete and minimize delays by creating new and effective methods. - Verify and maintain accurate records for new and existing provider's (NP, PA, CP, and PCT) licensure, NPI, taxonomy codes, insurance, CDS, DEA certificate, education, hospital privileges, board certifications related requirements for participation with Medicaid, PeachCare for Kids and Medicare. - Report needed credential data to other departments as appropriate, i.e. status of practitioner's professional license and DEA, if applicable. - Communicate changes in affiliation status, employed practitioner status, office address(es) and other information to TSPMG HR Services, Provider Contracting and other departments as appropriate. - Assist with the Credentials & Privileging Committee meeting preparation to include, but not limited to: organizing, set-up, minutes, provide necessary reports, member sign-in sheets, post-meeting clean-up and other duties related as assigned. - Active participation in team/department meeting and assist department in identifying areas of opportunity while driving solutions. - Perform a variety of administrative duties to include processing incoming mail, sending written inquires, and maintaining processes. - Assumes additional responsibilities and performs special projects as needed or directed.
Qualifications: Basic Qualifications: Experience - N/A. Education - Associate's degree in the health care or technical field OR two (2) years of experience in a directly related field. - High School diploma or General Education Development (GED) required. License, Certification, Registration - N/A.
Additional Requirements: - Able to write reports, business correspondence. - Certified Public Notary. - Demonstrates and applies expertise in operational workflows, research, and analytical skills. - Excellent telephone skills, customer service skills, strong organizational skills needed with attention to detail and be accustomed to extensive follow-up on pending submissions in a timely manner. - Experience working routinely with physicians and/or senior executives. - Highly organized. - Knowledge and experience in credentialing tracking/database system. - Strong computer and data entry skills with intermediate knowledge of Word, Excel, credentialing software (Visual Cactus), and internet experience.
Preferred Qualifications: - Minimum two (2) years of Credentialing Experience. - CPCS (Certified Provider Credentialing Specialist) preferred or actively seeking certification and ability to become certified within three (3) years.
COMPANY Kaiser PermanenteTITLE Specialist, Credentialing Medicare & Medicaid - AtlantaLOCATION Atlanta, GAREQNUMBER 612669
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.