Credentialing Specialist

Reports to: Senior Manager of Quality and Corporate Compliance Job Summary The Credentialing Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing and recredentialing, documentation for providers, clinicians and other billable providers. Primary Duties and Responsibilities Responsible for Compiling and maintaining current and accurate data for all providers Responsible for Data entry and maintaining provider information in online databases and systems (CAQH, PECOS, and NPPES, Availity and any other systems as required.) Responsible for Verification of State license, DEA, and Board certification Ensures all required documentation is presented to government payers to receive provisional status to practice and be eligible for reimbursement Responsible for Completing provider initial and recredentialing applications Audits applications for accuracy and completeness Responsible for revalidation requests issued by government payers Responsible for Submitting completed credentialing and re-credentialing applications and supporting documentation to all requested payers Compiles and maintains current data and master grid of all providers for agency roster Maintains knowledge of current agency, state, county, and payor requirements for credentialing Responsible for monitoring application progress and following up with necessary parties/payers as needed until confirmation of "in network" status has been received Responsible for monitoring and maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. As well as tracking all state licenses, DEA, and board certification expirations for all providers to ensure timely renewal Responsible for sending monthly updates to supervisors, program leads, and providers/clinicians Utilizes strong research skills to gather pertinent information regarding providers Assists in compilation of documents for audits conducted by Regulatory Agencies Collaborates and executes Quality Assurance and Compliance Projects and Tasks as a Quality and Compliance Assistant including support of the Council of Accreditation Re-Credentialing Process and other related Quality and Compliance Administrative Tasks. Undertakes additional projects and responsibilities as assigned by management to support the overall goals of the organization All other duties as assigned Qualifications Associate degree and a minimum of 2 years related experience preferred; or at least four years related experience and training Working knowledge of credentialing accreditation regulations, policies, and procedures Certified Professional Credentialing Specialist (CPCS) certification preferred Payer Provider Enrollment: 1 year (Preferred) Non-Profit: 1 year (Preferred) Skills Required Familiar with provider credentialing and recredentialing requirements Strong analytic computer and software skills Excellent interpersonal skills including excellent verbal and written communication skills Ability to demonstrate a high degree of trust and confidentiality Ability to work independently and assume assigned responsibilities Skilled in efficiency, organization, time management, and prioritization Ability to be flexible and function well in a fast-paced environment Ability to communicate effectively and relate to people of diverse cultures Ability to handle confidential information Working Conditions Able to sit and work at a computer for extended periods Able to lift and move up 15 pounds occasionally Flexible schedule required; Requires regular and on-time attendance This description is intended to describe the type and level of work being performed by a person assigned to this job. It is not an exhaustive list of all duties and responsibilities of a person so classified. The employee is expected to adhere to all company policies and perform other duties as assigned for the good of the consumers, the program, the department and the agency. #J-18808-Ljbffr