Credentialing Specialist

Job Title: Credentialing Specialist

Location: Winton Road Site, Rochester, NY 14623

Salary: $19.00 - $24.00 per hour commensurate with experience

Employment: This is a full-time 37.5 hours per week position. Days and hours of work are Monday through Friday during business hours 8:00am – 4:00pm. Evening work may be required as job duties demand.

Summary/Objective: To ensure all program or departmental services provided by the agency are focused on accomplishing the CP Rochester mission, vision and organizational values and that the services meet the goals of the department and the other agencies as needed. Ensures the 3 agencies are appropriately credentialed, up to date in certifications and insurance as well as ensuring therapists are credentialed for appropriate payment reimbursement.

Required Education and Experience:

• High School Diploma or equivalent GED. Associates degree preferred.
• Demonstrated ability to plan and organize the daily operations of the department or program.
• Demonstrated ability to effectively communicate orally and in writing.
• Demonstrated tolerance for stressful interactions and situations.
• Demonstrated proficiency with Microsoft Office Programs.
• Knowledge and proficiency in use of Electronic Health Record System
• Additional Eligibility Qualifications: Continue to maintain eligibility with staff checks and background checks.
• Maintain current NYS driver license.

Essential Functions:

• Imparts agency philosophy of “Equal Opportunity, Independence and Realization of Individual Potential” to children, families, program staff and community resources.
• Maintains confidentiality of information relating to individuals and their families in accordance with agency policy.
• Ensures clinic compliance with regulatory agency such as OPWDD, DOH, NYSED, NYS Insurance Laws.
• Completes all credentialing for all current Therapists/Social Workers/MDs/Dentists/Hygienists and any new hires which includes but is not limited to current insurance companies that CP Rochester and Happiness House is a participating provider. These include currently: Medicare, Medicaid, MVP, Excellus, Cigna, UHC, Railroad Medicare, Medicare Advantage Plans, Aetna and others as needed
• Updates CAQH for credentialing as needed for insurance companies
• Completes credentialing or revalidation for agencies as deemed necessary by CFO or COO.
• Properly maintains all files in order to assist with any audit function.
• Works within the PECOS system to ensure proper credentialing of therapists, dentists, MD’s and LMSW/LCSW/Psychologists.
• Supports continued relationships between insurance companies and CP Rochester, Happiness House and Rochester Rehabilitation as needed in order to maintain contacts for correspondence.
• Supports person centered services in a team model.
• Provide reports and documentation to managers and directors on a regular basis as assigned.
• Communicates in a positive manner agency, regulatory body and departmental or program policies, procedures and standards of work. Shares important information regarding the safety and welfare of others.
• Implements specific job assignments in a timely and accurate manner.
• Communicates effectively with staff, service providers, individuals, caregivers, family members, and the community.
• Communicates with management, supervisory, and clinical staff at all locations in order to ensure timely filing and approval of revalidations (agency or individual).
• Demonstrates professional demeanor and serves as a role model for other staff and individuals.
• Ensures that all aspects of the quality assurance plan are carried out.
• Develop and maintain an excellent working relationship between CP Rochester, Happiness House and partnering agencies (CDS, LAI)
• Participates in conferences, workshops and in-service training as needed or recommended to enhance job skills and personal growth and development.
• Adheres to agency’s policies and procedures as well as department guidelines.

Competency Requirements

• Ethical Practice
• Communication Proficiency
• Collaboration Skills
• Customer/Individual Focus
• General, Verbal, and Numerical Intelligence

Supervisory Responsibility: None.

Other Duties: 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.

Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment.

Physical Demands: 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. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit, stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee must frequently lift and/or move objects up to 10 pounds and occasionally lift and/or move objects up to 30 pounds.

Travel: Travel is primarily local during the business day but employee will be expected to work at any of our partner agencies. Some out-of-the-area and overnight travel may be expected.

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, relevant qualifications, internal equity, and location.

EEO Statement: The agencies are equal opportunity employers. We do not discriminate against employees or applicants in the hiring, promotion, compensation, placement, termination, layoff, recall, transfer, leaves of absence or any other term or condition of employment on the basis of race, color, religion, sex, sexual orientation, gender identity/expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran, domestic violence victim status, prior arrest and conviction records or any other protected category in accordance with applicable federal, state and local laws.