Payor Credentials Specialist (Full-Time) - Medical Staff Credentials

Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.

1. Job responsibilities include those listed in competencies document
2. Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
3. Collaborate with Medical Staff to submit payor applications for payor participation status.

4. Collaborates with Medical Staff to submit revalidation applications in a timely fashion to maintain participation status.

5. Maintains good communication with AVP’s, VP’s, Administrators, Billing department and Credentials colleagues to ensure all parties are aware of concerns or issues with payor credentialing process.

6. Continues to identify the most efficient method of submitting financial credentialing applications.

7. Communicates payor concerns or issues to Departmental Director and if needed, Managed Care Director to ensure positive relationship with payors.

8. Other Duties as assigned by Supervisor.

Qualifications:

1. Extensive communication skills both verbal and written

2. Problem solving and organizational skills

3. Conflict negotiation skills

4. Clerical skills with emphasis in resource management

5. Ability to insure the confidentiality of issues

6. Strong computer skills including skills in Microsoft Office suite.

Licenses/Certifications/Registrations/Education

Education/Experience:

Associate degree with one (1) year of work experience related to Medical Staff Credentialing or other provider related regulatory process management/oversite or other relevant experience. OR

High School Diploma or Equivalent with at least four (4) years of experience related to credentialing or other provider related regulatory process management/oversite or other relevant experience.

Certification: CPCS (Certified Provider Credentialing Specialist) encouraged within 24 months of hire.

Physical Requirements: Refer to Occupational Risk Assessment