What are the responsibilities and job description for the Credentialing Specialist position at Northern Nevada HOPES?
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The purpose of the Credentialing Specialist is to provide oversight and accuracy for data entry of enrollment and post enrollment information into required health plan systems on a daily basis.
Under the supervision of the Director of Human Resources, the Credetialing Specialist is responsible for applying, analyzing, organizing, storing and maintaining Provider Enrollment documents and verifying credentials and licensing information is accurate upon enrollment application and roster submissions to all HOPES Payors.
The ideal candidate will demonstrate strong aptitude for setting up and keeping meticulous records. There must be a strong attention to detail. The candidate must be extremely organized and possess excellent communication and superb customer service skills. They must be able to communicate effectively with all departments and insurance contacts. They must have the ability to work independently, set priorities and meet deadlines with a strong sense of urgency. This position requires someone who is results oriented, excellent problem solver and has top computer skills.
What Will You Do
At HOPES, all employees serve as ambassadors to our patients and the community. Your co-workers at HOPES are one of the many contributing factors to HOPES being named one of Northern Nevada's Best Places to Work three times in the last five years. To learn more about the Key Accountabilities of HOPES Squad members, take a look at https://www.nnhopes.org/wp-content/uploads/2020/03/HOPES-Squad-KAAs.pdf.
Fit is as important as function at HOPES. We enjoy a VERY special collaborative culture that thrives on open communication and valuing everyone's contribution to the team. We are as unique as the populations we serve! However, we all agree on our dedication to optimizing wellness for the people we serve and understand we ALL are responsible for the mission of Northern Nevada HOPES.
To find out more about HOPES, visit our website at https://www.nnhopes.org/. We have a great mission and have been inducted into the Best Places to Work Hall of Fame. All our careers are listed on our Careers page at https://www.nnhopes.org/about/careers/. If you'd like to learn more about what HOPES is doing in the community, sign up for our newsletter at https://www.nnhopes.org/newsletter/.
Northern Nevada HOPES is a Federally Qualified Health Center and Patient Centered Medical Home.
We are a Drug-Free Workplace and utilize E-Verify to comfirm work eligibility.
The purpose of the Credentialing Specialist is to provide oversight and accuracy for data entry of enrollment and post enrollment information into required health plan systems on a daily basis.
Under the supervision of the Director of Human Resources, the Credetialing Specialist is responsible for applying, analyzing, organizing, storing and maintaining Provider Enrollment documents and verifying credentials and licensing information is accurate upon enrollment application and roster submissions to all HOPES Payors.
The ideal candidate will demonstrate strong aptitude for setting up and keeping meticulous records. There must be a strong attention to detail. The candidate must be extremely organized and possess excellent communication and superb customer service skills. They must be able to communicate effectively with all departments and insurance contacts. They must have the ability to work independently, set priorities and meet deadlines with a strong sense of urgency. This position requires someone who is results oriented, excellent problem solver and has top computer skills.
What Will You Do
- Responsible for recording, analyzing, organizing, storing and maintaining incoming documents and information from HR and provider offices.
- Preliminary provider enrollment verification upon receipt of enrollment applications and accompanying documentation
- Reviews enrollment applications for completeness and accuracy
- Queries necessary sources to verify information on applications
- Maintains accurate and up to date credentialing provider files
- Data entry into credentialing database
- Submits provider enrollment applications to all network payors
- Ensures all provider CAQH, NPI, and state requirements are met and updated annually
- Submits payor requests for network participation
- Build knowledge base for payor requirements and forms.
- Develop working knowledge of payor and policies and requirements
- Submits updates to payors for address changes and/or provider changes
- Maintains all payor requirements for credentialing.
- Works closely with Billing Department to respond to any claim denials or benefit issues related to provider credentialing.
- Meets all federal and state guidelines when processing applications
- Follow up and check status of applications with payers
- Requests and files applications, enrollment documents and supporting material.
- Establishes and maintains detailed provider relations application process (including sample applications), specific state requirements, with name, address, and phone number of the contact people at each intermediary for assigned areas
- Conducts or assists with the investigation and appropriate reporting of adverse or incomplete information.
- Coordinates credentialing correspondence. Maintains confidentiality of information processed.
- Monitors and evaluates the center’s relevant employment and credentialing policies and procedures, and make suggestions for improvements, as needed.
At HOPES, all employees serve as ambassadors to our patients and the community. Your co-workers at HOPES are one of the many contributing factors to HOPES being named one of Northern Nevada's Best Places to Work three times in the last five years. To learn more about the Key Accountabilities of HOPES Squad members, take a look at https://www.nnhopes.org/wp-content/uploads/2020/03/HOPES-Squad-KAAs.pdf.
Fit is as important as function at HOPES. We enjoy a VERY special collaborative culture that thrives on open communication and valuing everyone's contribution to the team. We are as unique as the populations we serve! However, we all agree on our dedication to optimizing wellness for the people we serve and understand we ALL are responsible for the mission of Northern Nevada HOPES.
To find out more about HOPES, visit our website at https://www.nnhopes.org/. We have a great mission and have been inducted into the Best Places to Work Hall of Fame. All our careers are listed on our Careers page at https://www.nnhopes.org/about/careers/. If you'd like to learn more about what HOPES is doing in the community, sign up for our newsletter at https://www.nnhopes.org/newsletter/.
Northern Nevada HOPES is a Federally Qualified Health Center and Patient Centered Medical Home.
We are a Drug-Free Workplace and utilize E-Verify to comfirm work eligibility.
