Job description

Delaware Valley Community Health, Inc. (DVCH) is a federally-qualified, not-for-profit, community-focused health care organization dedicated to providing the highest quality, affordable, and accessible primary medical, dental and behavioral health care to our patients regardless of their ability to pay in North Philadelphia, Norristown and Delaware County areas.

Our mission is fulfilled by exceptionally dedicated and qualified professional and support staff of various backgrounds and cultures. We are a mission driven organization providing the highest quality care to all members of the communities we serve.

DVCH is committed to providing a safe and healthy work environment for our employees, patients, and visitors. In effort to achieve this goal, DVCH requires all employees, regardless of position, to be vaccinated for COVID-19. If an employee is unable receive the vaccine for medical or religious reasons, a vaccine exemption form must be completed and submitted to the Employee Health Department. Medical exemptions will be reviewed and approved in coordination with the Chief Medical Officer and religious exemptions will be reviewed and approved in coordination with the Chief Human Resources Officer.

Delaware Valley Community Health (DVCH) is currently recruiting for an experienced Healthcare Insurance Credentialing Specialist to be a part of our team. Under the direction of the Senior Director of Revenue Cycle Management, this position is responsible for processing the credentialing and re-credentialing insurance applications for our healthcare providers at our community focused health centers, both on paper and online for the providers, including updating and maintaining in the CAQH database. This position will be located at our Administrative Offices in North Philadelphia.

Duties:

• Work closely with provider on-boarding team at DVCH
• Initiate and maintain provider enrollment with Medicare / Medicaid as well as participated insurance companies
• Manage site revalidation process
• Initiate new site enrollment with Medicare and Medicaid and assist in insurance new site communication
• Maintain provider roster information for insurance companies
• Identify trends or issues, rectifies when appropriate and alert management to concerns
• Follow up with insurance carriers regarding status of credentialing process
• Communicate with Central Billing Department regarding providers and their credentialing status
• Assist Central Billing Office if there are credentialing concerns raised based on claim denials
• Meet or exceed all deadline requirements for provider communications, enrollment and follow up
• Act as liaison to resolve credentialing related inquires
• Establish and preserve quality working relationships with internal and external customers.

Qualifications:

• High School diploma or equivalent.
• Associates degree or equivalent education and experience.
• Experience within healthcare billing, health plans and/or governmental payer insurance credentialing and enrollment REQUIRED.
• High computer literacy, including Microsoft Office Suites REQUIRED
• Demonstrated ability to exercise independent judgment and maintain confidentiality.
• Database management skills including querying, reporting, and report generation PREFERRED.
• Demonstrate excellent customer service, communication, and interpersonal skills.
• Ability to work within deadlines and time restraints and facilitate workflow independently as well as part of a team with minimal supervision.

DVCH is an EOE/Veterans/Disabled/LGBTQ+ employer. For more information about DVCH and its services, visit us online at www.dvch.org

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