Contracting & Credentialing Team Lead

• About The Auctus Group LLC

Who we are: We’re big on people and culture at the Auctus Group. Our most important role as a company is to provide an amazing working environment for our team. We’ve been work-from-home-warriors since before it was cool. We support (like encourage and fund) continuing education. We match charitable donations. Our whole goal is: work to live not live to work. Oh and we’re weirdos too…we do remote happy hours and have a book club and goofy stuff like that.

Who we’re looking for: Smart, talented, tech-savvy, experienced, go-getter types. You’ll do well if:

• you like a fast-paced environment,
• you thrive with change and development,
• you like giving feedback,
• you’re a team player,
• you love learning/sleuthing,
• you’re big on accountability.

About the role

●       Conduct all follow up steps till payor approval/completion is obtained

●       File provider practice change notifications and perform follow up duties till confirmed complete by payors.

●       Update NPI records according to provider specifications.

●       Enroll providers in Medicare/Medicaid as prescribed by each program requirements.

●       Track provider licensure and board expirations and ensure timely processing CAQH, and payor updates.

●       Complete requests for re-credentialing for both providers and facilities.

●       Accept and process all requests from payers for credentialing information/updates/new contracts and products

●       Answer questions, process requests from staff/providers related to credentialing information.

●       Address enrollment disconnects regarding facility and providers

●       Complete ERA/EFT enrollment, tracking and filing, clearinghouse (Availity RCM, CAQH, Enroll hub etc.)

●       Maintains in quarterly CAQH mass attestation

●       Serves as liaison between outside organizations and external customers.

●       Manages the creation/ maintenance of our Availity, Optum & Medicare as it pertains to usage by providers & third-party users.

●       Ability to submit accreditation applications and follow up until approval is obtained.

●       Knowledge of licensing application processes across different states.

●       Proficiency in creating Group NPI (GNPI) and Individual NPI (INPI) through NPPES.

●       Familiarity with Modio, Pipedrive, and LastPass is a plus.

●       Experience in submitting hospital privileges/initial appointment applications and managing follow-ups until approval.

●       Experience in submitting and tracking DEA applications until approval.

●       Experience in Maintaining the Provider’s CAQH.

Qualifications

• Ability to assess problem areas and address them effectively.  
• Managing one’s own time and the time of others. 
• Written and verbal communication skills are essential to be successful in this position. 
• Working towards one goal of serving clients needs.  
• Previous experience with computer applications, such as Microsoft Office Suite (e.g., Word, Excel, Teams), Adobe, softphone (e.g., RingCentral), web browsers and so on.. 
• Must have excellent organizational and communication skills at all levels, both verbally and in writing. 
• Strong attention to detail.
• Must be able to address, track and solve problems. 
• Ability to multi-task in a fast paced environment. 
• Ability to work full time hours during regularly scheduled business hours and additional work hours as needed. 
• Ability to work from home with integrity. 

Skills and Abilities

• Ability to organize, set priorities, work independently and work well with a diverse group of people is essential.
• Ability to work effectively as a team member with a strong collaborative management style.
• Ability to think and act strategically and proactively.
• Excellent computer skills including Microsoft Office Suite (Outlook, Word, Excel).
• Knowledge of medical terminology, revenue cycle processes including: health insurance verifications, billing, collections, cash posting functions and coding is a plus.
• Proficiency in reading, writing, and communicating in English. Bilingual skills are a plus.
• Contracting and Credentialing System usage experience is a plus**
• Strategy and negotiation tactics with Contracting and Credentialing is a plus**

Required Experience

• 1-3 years’ experience in contracting and credentialing field, with knowledge of organizational effectiveness and operations management
• Ideal candidate will have experience in a multi-entity organization in the healthcare industry
• Proven work experience as Contracting & Credentialing Lead or similar role
• Outstanding organizational skills
• Plastic and Dermatology experience is a plus

Physical Demands

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job from home. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job the employee is:

• Regularly required to sit and talk or hear.
• Regularly required to use a computer keyboard and mouse.
• Frequently required to use hands, handle, or feel; reach with hands and arms.
• Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and ability to adjust focus. 

Work Environment

This job operates in a remote environment. This role routinely uses standard office equipment such as computers, phones, printers, etc.

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