Credentialing Specialist- Part Time

SUMMARY:

This position is located in Warwick, RI. Flexible Day Shift Hours, 20 hrs./week

Under immediate supervision of the Supervisor of Patient Financial Services, has primary responsibility for all aspects of provider credentialing for Rhode Island Medical Imaging. Relies on instruction and pre-established guidelines to perform the functions of the position. This position assists the medical staff office at all hospital facilities. Complete all insurance credentialing applications. The position is a key component of the cash flow for the institution.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Consistently applies the corporate values of respect, honesty, fairness and constant pursuit of excellence in improving the health status for the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a diagnostic imaging company.

Ensures that all interactions are in compliance with HIPAA, federal and state compliance regulations.

Responsible for hospital privileging, credentialing and re-credentialing all RIMI physicians, physician’s assistants and fellows.

• Maintains the CAQH database.

• Understands all elements associated with obtaining state medical licenses, Medicare

NPI numbers and all other payor credentials for participation. Keeps current with all

insurance changes regarding policy and credentialing guidelines.

• Work closely with medical staff offices, licensing agencies and insurance carriers contacts.

• Ensures insurance companies receive and process credentialing and re-credentialing applications in a timely manner through diligent follow-up.

• Initiates and completes credentialing packets for new providers as soon as notified.

• Keeps a database of all providers’ information and current spreadsheets on statuses.

• Generates an exit packet, i.e. NPI#, malpractice information, etc. for terminating

physicians.

Understands all elements associated with completing hospital privileging applications, insurance applications and credentialing software.

Recommends modifications to RIMI’s billing system based on knowledge of credentialing changes.

Maintain MRI/CT volume reports for ACR.

Takes initiative relative to duties, pointing out possible issues or concerns to the Supervisor and/or Manager of Patient Financial Services.

Ability to adapt, in a timely manner, to changes in credentialing rules as defined by insurance companies, hospital staff and/or Management.

Ability to work in a team environment, including cross training co-workers to assist when necessary when directed by the Supervisor, Manager and/or Executive Director of Patient Financial Services.

Maintains a professional manner at all times.

Participates in meetings on an as requested basis.

Performs other duties as assigned.

Performs special projects as assigned by the Supervisor and/or Manager of Patient Financial Services.

REQUIRED KNOWLEDGE:

Excellent telephone and interpersonal skills are essential. Must be able to handle and prioritize work load and work as a team member. Advanced understanding of hospital, governmental and insurance company credentialing requirements and processes.

EXPERIENCE:

High school graduate or equivalent. Three to five years of direct medical credentialing experience required.

About Rhode Island Medical Imaging:

Rhode Island Medical Imaging (RIMI) has a network of 12 private state-of-the-art medical diagnostic imaging facilities that are staffed by over 70 board certified radiologists with broad-based experience and subspecialty training in Bone Densitometry (DEXA), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) including the most extensive 3T MRI imaging network in Rhode Island, Mammography, Ultrasound, and X-ray.

RIMI radiologists perform and interpret imaging in Rhode Island at Hasbro Children’s Hospital, Miriam Hospital, Our Lady of Fatima Hospital, Rhode Island Hospital, Roger Williams Medical Center, and Women & Infants Hospital, and most recently at Sturdy Memorial Hospital in Attleboro, MA. Most of RIMI’s radiologists are also faculty members at the Warren Alpert Medical School at Brown University.

For over 75 years RIMI has provided Rhode Island with imaging excellence (since 1943).

*** Benefits offered include medical, dental, vision, life and disability insurance; AFLAC; paid vacation, sick and holidays; 401K and retirement plan.

To Apply

Please submit resumes to Jennifer Voyer at employment@rimirad.com.