About Sound:

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology, and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Self-managed PTO Plan
• Ten company-paid holidays per year

About the Role:

The Payer Credentialing Specialist is responsible for researching payer credentialing and billing issues and will work in conjunction with the Manager of Payer Credentialing in order to identify issues with the external Provider Enrollment vendor and the internal payer credentialing team. Additionally, will utilize a variety of proprietary and external tools in order to research and resolve provider enrollment issues. This may require contact with the Hospital Coordinators, operation personnel and/or insurance companies via phone, email or website.

Essential Duties and Responsibilities:

• Works closely with external payer credentialing vendor on notification of a provider's start, welcome packets, provider documentation and ensuring the provider is in all systems.
• Researches and resolves billing vendor holds from insurance carriers forwarded to Sound Physicians by the external billing vendor using a variety of methods dependent on the reasons.
• Performs follow-up with Sound Physicians market locations as needed in order to research and resolve provider enrollment issues.
• Performs follow-up with insurance payers via phone, email or website to resolve payer credentialing issues.
• Manage the completion and submission of provider enrollment applications.
• Perform tracking and follow-up to ensure provider numbers are established and linked to the appropriate Sound Physicians group entity in a timely manner.
• Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations.

• Maintain documentation and reporting regarding provider enrollments in process.
• Retain records related to completed payer credentialing applications.
• Work closely with program site management and Sound Physicians central services resources to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
• Establish close working relationships with privileging coordinators, contracting department, medical management, and payer contacts.
• Performs other duties and special projects as assigned.

Confidentiality

• Maintains strict confidentiality with regard to protected health information understands and adheres to Sound Physicians HIPAA Privacy & Security policies and procedures.
• Maintains strict confidentiality regarding provider information

Knowledge, Skills, and Abilities:

• Expertise in Microsoft software products including Word, Excel, and Outlook.
• Must be detail oriented and thorough in order to ensure the complex enrollment packages are complete and correct.
• Must be able to communicate well with a wide variety of contacts at all levels of the organization.
• Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.
• Must be an organized "self-starter" requiring little supervision in order to focus on and accomplish tasks.

Education and Experience:

Education

• High School Diploma or GED required

Experience

• 1 + years of Payer Credentialing experience required

Other details:

• Indoor office environment
• List physical Sitting at desk for up to eight hours (w/breaks)
• Working on computer for up to eight hours (w/breaks)
• Moving/lifting file boxes (up to 25 lbs.

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.