Credentialing Specialist; WFH

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At Rotech Healthcare Inc., we’re more than a medical equipment provider—we’re a trusted partner in patient care. As a national leader in ventilators, oxygen therapy, sleep apnea treatment, wound care, diabetic solutions, and other home medical equipment, we empower patients to manage their health from the comfort of home.

With hundreds of locations across 45 states, our team delivers high-quality products, exceptional service, and compassionate support that helps patients live more comfortably, independently, and actively. Whether you're a clinician, technician, or healthcare administrator, your work at Rotech directly improves lives.

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We are seeking a dedicated Credentialing Specialist to join our team. In this position, you are responsible for the complete credentialing process as defined by payer credentialing policies and procedures including provider manuals, contract language and requirements to ensure Rotech compliance and contract performance standards are met for all Rotech Locations. Position responsibilities also include re-credentialing, submission of COIs and licensure expirations, LANs, provider acquisition reporting and ensuring Rotech’s compliancy with the No Surprise Act.

Work From Home after successful completion of IN OFFICE TRAINING and are meeting expectations with management approval

(Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.)

• Administration of contracts includes but not limited to a complete review of payer contract language, policies and procedures, provider manuals, billing rules and guidelines
• Analyzes monthly trend reports (Held Item, Adjustment Analysis) to identify additional research and/or updates required to Contract/ Item Master
• Assigns and updates necessary contract classifications for Managed Care/Government Reporting purposes
• Assist with projects at BCC when access to older billing rules, HCPCs, ICD9, etc. is required to process claims in arrears (monitor window of claims processing to ensure no inaccurate billing occurs during project time frame)
• Assists in creating and maintaining Rotech’s Supplier Diversity Database including yearly mailing to all Rotech vendors
• Communicates with Purchasing on appropriate base contract pricing
  - Contract
• Communicates with the Billing Center, Central Intake, Sleep Central and Locations regarding contract changes and/or updates including distribution of reference guides as required
• Completes payer credentialing and re-credentialing applications via hard copy, email, fax or online based on payer specifications
• Conducts conference calls with payors as required
• Conducts Contact implementations with appropriate departments as well as payer in-services as required
• Conducts/leads calls with payers regarding changes and/or updates to payer rules, processes, guidelines, pricing methodologies and credentialing practices
• Creates and maintains job aids and training materials as it relates to contract and credentialing functions and systems used within CAD
• Creates FOIA requests as appropriate
• Files yearly government reports such as Subcontracting report, CCR registration, Vets-100
• Maintains Contract Quick Reference Guides on the Rotech Home Page
• Maintains current Location database spreadsheet and COIs
• Maintains database of contracts within shared drive, e-Intake and Contract Logix
• Maintains database of credentialing/re-credentialing within Laser Fiche and shared drive
• Maintains Location Dashboard information so assigned contracts appear on appropriately contracted locations
• Maintains monthly LANs updates and appropriate payer notification
• Maintains pricing and other updates within the online ordering system as required
• Maintains timely filing…