What are the responsibilities and job description for the Mental Health Credentialing Specialist position at BrightSpire Health?
Mental Health Credentialing Specialist
Join a collaborative and quickly growing Oregon mental health group practice that provides the highest standards of clinical care. BrightSpire Health is seeking to build an internal credentialing team, and looking to add a credentialing specialist who may also support our billing specialist. This role may be up to 40 hours/week. This is an hourly position to start, and offers competitive compensation and benefits, including PTO and 401k. Must have excellent references.
Focus is on individual(s) that are committed to thorough and organized tracking of initial credentialing and renewals. Must be familiar with individual payer processes of credentialing across commercial, Medicaid and Medicare. Building strong relationships with payers and offering timely responses to payers and all members of the team a must. Our future team member will be a highly valued and integral part of BrightSpire. (Must live in Oregon and be willing to commute to our Beaverton, or NE Portland location). Potential of hybrid.
Submit resume to: admin@brightspirehealth.com
Credentialing Specialist Responsibilities:
-Conduct initial credentialing application reviews and summarize results for recredentialing committee
-Ensure compliance with National Committee for Quality Assurance (NCQA) credentialing standards
-Maintain provider database and ensure the timely and accurate submission of data and reporting for provider correspondence, the Plan's Information Services Department, Management Service Organization (MSO), and other appropriate usage
-Act as liaison between the Plan and providers regarding credentialing and re-credentialing activities in consultation with the recredentialing committee
-Maintain provider credentialing files in compliance with regulatory standards
-Maintain current knowledge of regulatory requirements and standards with regard to credentialing
-Schedule biweekly Credentialing Sub-committee meetings
-Communicate changes to credentialed provider network and to appropriate departments/staff
-Coordinates provider credentialing process to increase efficiency and ensures that payer (e.g.Cigna) credentialing deadlines are met
-Support providers in establishing, updating and maintaining CAQH
-Excellent organization and regular timely tracking, management and submission of payer applications
-Confidence in use of a credentialing tracking system/application
Credentialing Specialist Qualifications: (up to 40 hours/week) Hybrid, and must be willing to commute to Beaverton or NE Portland, Oregon.
- An Associates degree or higher education
- Certification in credentialing a plus (CPCS, etc.)
- Establishing and maintaining a system for timely processing of credentialing and re-credentialing files in accordance with the company, CMS and NCQA policies. We are open to recommendations of credentialing software you have previously worked with and find effective.
- Bonus if you have instant knowledge of who to contact, and what each individual payer (commercial, Medicaid, Medicare) needs to initiate and maintain credentialing.
- Ensuring that providers/HDOs on the company's participating panel are in compliance with the company policies and NCQA and state and federal regulatory standards
- Maintaining current knowledge of NCQA, State and Federal requirements
- Performing data entry in and maintaining currency of the database for tracking practitioner / HDO credentialing and re-credentialing information
- Initiating and conducting primary source verification of provider credentials
Submit resume to: admin@brightspirehealth.com
