Credentialing Specialist - Full Time - Everett

Credentialing Specialist - Full Time, Everett

Compass Health is currently looking for an Credentialing Specialist to join our Finance Team.

What you will be performing

The Credentialing Enrollment Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing and recredentialing process. Facilitates all aspects of Compass Health credentialing, including initial appointment, reappointment and expiration processes for all workforce members who provide client services ensuring compliance with regulatory bodies (NCQA, CMS, HCA, federal and state), as well as policies and procedures, and delegated contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws related to credentialing. Serves as the initial point of contact for all credentialing functions.

• Processes credentialing requirements in a timely manner for successful revenue cycle billing and collections.

• Compiles, audits and maintains an up-to-date and accurate centralized master roster for both internal use and submission to external parties.

• Initiates, logs, and tracks provider credentialing/enrollment applications and re-credentialing processes. This includes submitting provider enrollment and re-credentialing applications according to established schedules, monitoring receipt and executes follow-up until all documentation is received and complete.

• Creates systems to monitor and track status of applications and maintenance of re/credentialing files.

• Conducts file maintenance to ensure re/credentialing file compliance with company policy and any regulatory and accreditation standards.

• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

• Coordinates processes and verifies data with PSS, AR. Quality and Operations as needed.

• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

• Assists with the communication, coordination and monitoring of physical location enrollments / updates with payers.

• Communicates regularly with contracted health plan representatives on credentialing and physical location enrollment matters, including application status, required updates, and terminations.

• Documents clinician credentialing status and changes to shared internal access.

• Designs reports as requested to support contracting and credentialing efforts.

• Maintains knowledge of current payer and agency requirements for credentialing providers and physical location enrollments.

• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.

• Contributes to process and performance improvements in regard to provider enrollment, credentialing and revenue cycle management.

• Other related duties as assigned.

• Participates in regularly scheduled supervision and team meetings.

• Remains compliant with required trainings and certifications.

• Behaves in an ethical and professional manner consistent with agency policy, state law, and licensing entities if applicable.

• Understands and practices safekeeping of client protected health information per Compass Health’s HIPAA and other agency policies and procedures.

• Demonstrates respect for diversity and a commitment to developing multicultural competency and sensitivity.

• Demonstrates commitment to Compass Health’s Strategic Intention, core Values and Core Competencies.

What you will be carrying along

• High school graduate or equivalent.
• At least 2 years of experience directly related to clinical staff credentialing or managed care organization provider credentialing / physical location enrollment processes.
• Experience with credentialing software
• Experience with credentialing databases, i.e. ProviderOne, PECOS, ProviderSource, CAQH and NPPES.
• Experience working in a behavioral health care environment, preferred.
• Certified Provider Credentialing Specialist (CPCS), preferred.

What you will be sharing

• Knowledge of federal and state laws, regulations, and accreditation standards including NCQA, HIPAA, and CMS.
• Familiar with healthcare coding, and billing.
• Project management, analytical thinking, problem solving, and decision-making skills.
• Experience with data collections, data analysis, and data presentation.
• Highly self-motivated and directed with the ability to also work cooperatively with others as a productive team.
• Excellent customer service skills, with the ability to relate effectively and sensitively to a wide range of consumers and professionals.
• Ability to work calmly, effectively, and prioritize assignments in a fast-paced, high production, and high-pressure environment.
• Ability to maintain a high level of confidentiality.
• Ability to maintain a positive, solution-focused demeanor when responding to conflicts or problems.
• Demonstrated organizational skills with an emphasis on attention to detail.
• Effective oral and written communication skills.
• General computer proficiency, including thorough knowledge of Microsoft Office and SharePoint programs.
• Ability to pass pre-employment criminal background check, which may or may not include additional DSHS inquiry member.

What we will be offering

As the region’s largest non-profit community behavioral healthcare organization, we have been serving our clients and our communities for over 110 years. Our commitment to care doesn’t stop with our clients though, as we take pride in offering our employees the opportunity to work in a culture that promotes learning, growth, and advancement as well as a focus on employee satisfaction and work/life balance.

(benefits pro-rated for part time employees)

• Medical, dental, and vision insurance at NO COST to Full-time employees

• 16 days of paid vacation the first year

• 12 sick days with great wellness day

• 13 paid holidays – 11 regular and 2 that you choose

• Professional funds and paid education leave

• Up to 2% match for the 403B Retirement plan after the first year

• And much, much more!!

Additional Information

PHYSICAL DEMANDS / WORK ENVIRONMENT

The employee will be working in an administrative office environment. While performing the duties of this job, the employee must occasionally lift and/or move up to 20 pounds and is regularly required to sit, stand, walk, talk, and use close vision. The noise level in the work environment is usually moderate.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job in the work environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ABOUT US

Compass Health is the region’s largest private, non-profit organization providing mental health and substance use services in Snohomish, Skagit, Island, San Juan, and Whatcom counties of Western Washington. We provide quality creative services to children, families and adults in a variety of outpatient, residential and inpatient settings. We have been serving our clients and our communities for over 110 years, though our commitment to care doesn’t stop with our clients as we take pride in offering our employees the opportunity to work in a culture that promotes learning, growth, and advancement. We maintain a focus on employee satisfaction and work/life balance, which includes competitive compensation and benefits programs. Please visit our website for more information: www.compasshealth.org.

Compass Health promotes equal treatment and equal employment opportunity to all applicants and employees regardless of race, creed, color, national origin, sex, religion, age, marital status, sexual minority status, sexual orientation, veteran status, or disability unless based on a bona fide occupational qualification

Job Summary
Position Title: Credentialing Specialist

Program: 103-52550

Hours: Full-Time

Location: Everett

Wage: $28.24 - $41.14