Credentialing Specialist

JOB OVERVIEW: This position is responsible for managing provider enrollment, credentialing, re-credentialing, and enrollment for multiple behavioral health providers. It also assists with investigating billing issues related to contracting and credentialing. The position maintains up-to-date data for each provider in credentialing databases and online systems and ensures timely license and certification renewals.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

1. Oversees the accurate collection of provider documents and information needed to contract and credential providers with insurance plans.
2. Responsible for submitting initial and recredentialing applications to payers.
3. Manages multiple provider CAQH profiles, responds and completes attestations and verification related to providers.
4. Monitors applications and follows up as required and is able to respond to provider and department leadership related to the status of applications.
5. Identifies and maintains relationships with payer representatives to assist in any issues.
6. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
7. Stay current on current health plans and agencies within the cost centers being managed.
8. Audits health plan directories for current and accurate provider information.
9. Assist with department projects.

QUALIFICATIONS:

EDUCATION:

1. High school diploma or equivalent.
2. Associate degree preferred.

EXPERIENCE:

Two years of relevant payer enrollment, as well as CAQH and managed care contracting experience, is preferred.  

SKILLS:

1. Knowledge and understanding of the credentialing process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills, including letters, memos, and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.