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Waltham, Massachusetts, USAPermanent positionFull time

Credentialing Specialist

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PURPOSE AND SCOPE: 

The Credentialing Specialist is responsible for verifying submitted Credentialing documentation. for all specialties that provide services to the organization's members. The Credentialing Specialist incumbent will meet all credentialing turnaround time levels by submitting accurate and complete applications. The Credentialing Specialist will abide by all policies and processes to meet all state, regulatory, health/safety, and compliance guidelines.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Verifies and reviews all related  specialty  credentials,  including  but  not  limited  to  Medicare,  education,  training,  licenses,  and malpractice/professional liability insurance, CLIA licensure, facility surveys, as applicable.

  • Enters all provider information and primary source verification data into the related database.

  • Creates and maintains provider files in compliance with the organization's policies.

  • Completes payer enrollment and/or facility applications in a timely and complete manner consistent with Department goals and metrics.

  • Responsible for outreach to pertinent parties to obtain any needed documents that go along with credentialing applications as directed.

  • Escalates any missing items as directed to leadership in efforts to stay on task and avoid credentialing lapses

  • Abides by all policies, procedures, and work instructions for the credentialing function,

  • Assists in goals and performance standards management.

  • Ensures data integrity is maintained in related credentialing database and core system records.

  • Improves efficiencies and service provided while reducing costs.

  • Obtains DUNS number and complete online application process in SAMS to ensure the DUNS number is activated

  • Completes yearly revalidations and other requests regarding the DUNS number in SAMS to ensure correct information is loaded in the system to avoid delays in payment and obtaining authorizations

  • Attends trainings and references training materials including content, work instructions, and tools, as required

  • Obtains knowledge of credentialing regulatory and accreditation requirements (CMS, NCQA, etc.).

  • Performs monthly monitoring of expirations.

  • Performs quality checks.

  • Assists with various projects as assigned by direct supervisor.

  • Performs other duties as assigned.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Little to no travel is required.

SUPERVISION: 

  • None

EDUCATION: 

  • High School Diploma required

EXPERIENCE AND REQUIRED SKILLS: 

  • 2-4 years' related experience.
  • Previous experience in health insurance preferred.
  • Excellent customer/interpersonal skills.
  • Detail oriented with strong analytical and organizational skills.
  • Excellent oral and written communication skills.
  • Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database and email applications.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

Career with a purpose

Career with a purpose

We offer an opportunity to create and deliver treatments that save and change lives for the better. We’ll support your ongoing development. And you’ll be part of a dedicated team of people who inspire each other to create the best possible healthcare outcomes each and every day.
Inclusion and diversity

Inclusion and diversity

Joining Fresenius Medical Care means becoming part of a team that values diversity. We embrace the wealth of different backgrounds, cultures, experiences and opinions that make up our workforce and strive to create an inclusive atmosphere in which all our employees feel valued.
Stability

Stability

Developing innovative products and continuously improving our renal therapies made us the clear market leader in the production of hemodialysis machines, with sustainable, profitable growth . This position provides our 125000 employees with the stability and security they need to help improve the lives of our patients.
Learning and development

Learning and development

We offer participation in programs at world-class business schools, leadership development, regular training for our nurses, health care professionals and manufacturing staff and digital access to high-quality educational content for all employees worldwide 24/7. 
Local benefits

Local benefits

Our employees enjoy both local and global opportunities for growth and personal fulfilment. We offer local benefits designed to suit the requirements of the respective country and place of work to create ideal conditions everywhere.
Work-life balance

Work-life balance

We want to empower people to deliver better care. Therefore, we promote a better work-life balance through flexible working hours, part-time models, the possibility to work from home, and more.
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At a glance

Earliest possible start:

As from now

Contract type:

Permanent position

Company:

Fresenius Medical Care

Region / Business Unit:

North America

Location:

Waltham (Massachusetts, USA)

Working condition:

Full time

Job Function:

Legal & Compliance

Reference number:

R0177577

Publishing date:

10/16/2024

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Collaborative

We care about sharing information and experiences as this helps us learn from our mistakes and each other. We tackle challenges together by reaching out to colleagues both near and far. We communicate openly.

Proactive

We challenge the status quo and show interest in what happens around us. We ask questions to clearly understand what needs to be done and take ownership of the results.

Reliable

We live up to our own expectations, show respect and lead by example. We act with integrity and in line with our standards every day.

Excellent

We make things better today than they were yesterday. We pitch ideas on how to improve and innovate.

What we stand for

Empowering people. Advancing care. Inspiring with our purpose and values.

Everything we do here is about making people’s lives better, simpler and longer. Our teams work cross-functionally to reproduce the complex function of kidneys with treatments that meet high quality standards, improve clinical outcomes, and are sustainable and compliant. Internally, we promote diversity and inclusion as key elements of a positive, supportive work environment. Our values support our mission to develop high quality products and services, to have a positive impact on the health and wellbeing of patients, and to lead Fresenius Medical Care towards a successful, sustainable future.