Cranial Technologies manufactures the DOC Band®, a customized medical device that reshapes babies’ heads. We’re looking for someone who shares our passion for changing babies’ lives every day. In turn, we provide a strong collaborative culture where everyone’s contribution is valued.

This position will be responsible for monitoring all of the Company’s credentialing functions, including application management and primary source verification. Will communicate with outside agencies including physician offices, hospitals and other healthcare agencies as required. Ensures compliance with the appropriate accrediting and regulatory agencies. Works with other credentialing staff in the day-to-day management of the overall credentialing process and database management.

Responsibilities:

• Process health plan enrollment / credentialing applications for facilities and licensed providers with all government and commercial health plans
• Run weekly reports from the credentialing database / tracking tools to determine required follow-up with licensed providers and health plans.
• Enter contact and action notes into credentialing database / tracking tools to maintain accurate record of progress with health plans.
• Maintain credentialing database / tracking tools, updating provider and facility health plan identification numbers and other required database fields.
• Develop and maintain productive and positive working relationships with key local, regional and national Payers through their local market managers and regional executives
• Work with the health plans to assure mutual understanding and complete clarity in the written document
• Ensure contract files are in order and kept up to date and archived in compliance with records management policies and procedures
• Keep abreast of marketplace changes for third-party payers, networks, reimbursement issues and changes in legislation or in guidelines at the state and federal levels
• Collaborate with and review activities with other credentialing specialist
• Perform related duties as assigned by supervisor.
• Maintain compliance with all company policies and procedures

Requirements:

• Bachelor’s Degree in healthcare management or related field
• Three (3) years experience working with a healthcare company or health plan directly focused on facility/provider enrollment
• Proficient in the use of Microsoft Word and Excel; NPI (National Practitioner Identification on-line access); State licensing agencies on-line access and Internet Explorer for other internet access.
• Must be organized
• Ability to work well without daily supervision
• Desirable: experience with credentialing software utilization to streamline reporting and the overall credentialing process