Essential Job Functions
• Data collection and management
• Collects provider credentials and updates internal/external databases
• Streamlines onboarding process/workflow for individual providers, practice locations, and physician groups
• Interacts with varied levels of management, office staff, and physicians effectively to complete various elements of enrollment/credentialing
• Maintain confidentiality of personal provider information
• Keep provider data up to date in databases
• Ensures requisite licenses, malpractice coverage, and certifications are all current for all providers/groups
• Submit credentialing applications and supporting documentation in a timely manner to cover all dates of service for providers
• Maintain provider/group demographic info and rosters including terminations, add-on, etc.
• Individual revalidations with various insurance payors
• Coordinate and prepare reports in a timely matter; weekly and monthly
• Provide aggressive follow up with insurance payors regarding credentialing status
• Maintain deficiency reports for all credentialing applications, developments, and issues
• Maintain CAQH accounts for providers, including supporting documentation
• Address AR billing claim issues related to provider enrollments
• Supervision of start-up projects and expansions
• Other RCM initiatives that support the Omega scope of client services
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.
5 years of experience in provider enrollment/credentialing within a multi-location physician practice management company, RCM, or healthcare system.
Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves 350+ healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com
End-to-End Revenue Cycle Management Solutions:
Patient Access
- Scheduling & Registration
- Insurance Eligibility & Benefits Verification
- Prior Authorization
Mid-Revenue Cycle
- Medical Records Coding
- Charge Capture
- Chart Audit
- Chart Audits
- Clinical Documentation Improvement
- HCC Coding Review
Business Office
- Claims Management & Billing
- Payment Posting & Reconciliation
- A/R Management & Collections
- Denials & Appeals Management
- Underpayment Analysis & Recovery
- Data Analytics Platform (WhiteSpace Analytics)
Full Business Office
Care Coordination
- Remote Patient Monitoring
- Telephone/Message Nurse Triage
- Customer Contact Center
Health Data Curation
- Clinical Trial Data Solutions
- Real-World Data Curation
- AI/ML Model Validation and Enablement
- Registry Data Management
Payer Operations
- Risk Adjustment Documentation & Coding Review
- HEDIS Chart Abstraction
- Care Coordination
- Provider & Member Communication
- Utilization Management
- Claims Administration
- Member Management
- Provider Data & Network Management
Pharma:
Access
- Member Enrollment
- Benefit Verification
- Prior Authorizations
Affordability
- Patient Co-pay Assistance
Adherence
- Care Coordination
