Credentialing Specialist

Job Description

Job Description

Harbor is seeking a Credentialing Specialist to join the Toledo team! This position is responsible for the day-to-day operations of credentialing new and established health care providers and maintenance of clinical information and practice locations with payer sources in a timely and complete manner.

Position is full-time, 40 hours per week.

REQUIREMENTS  

Education :  

• High School Diploma or GED required.  

Experience :   

• Must have knowledge of medical terminology and at least two years of related experience.   
• Must have excellent communication skills, both verbal and written.  
• Must demonstrate an ability to meet deadlines in a multi-functional task environment.  
• Requires excellent organizational skills, an operational knowledge working with word processing, spreadsheets, data entry, electronic health record and practice management systems, and other computer related skills.  
• Must at all times maintain efficiency and timeliness in all daily activities.   
• Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.  
• Provides optimal customer service to meet the organization’s expectations.   
• Must at all times be able to maintain the confidentiality of privileged information.  
• Excellent project management with ability to follow up on projects and meet deadlines. 

Preferred Qualifications :    

• Associate degree in administration, health or behavioral science field preferred.   
• Behavioral Health experience preferred.  

Essential Functions and Primary Responsibilities:

1. Assists the Credentialing Coordinator in the day to day operations  
2. Performs the appropriate credentialing and privileging processes for both new and established health care providers in a timely and complete manner.  
3. Communicates with new staff in helping them to acquire their NPI, and of the sequential steps needed to begin the credentialing enrollment process, through completion.  
4. Provides third-party technical support to Harbor staff providing services under contract with managed care/insurance organizations and with other units within Harbor.  
5. Assists clinical staff in completing needed credentialing information.  
6. Maintains credentialing information in National Database and SmartCare.  
7. Works with many individuals to acquire necessary materials and information, including but not limited to: physicians, facility staff, professional staff, physician’s office staff and hospital staff.  
8. Performs relevant data entry into the database to ensure consistency and integrity of the data.  
9. Processes appropriate queries and assists providers in renewing expired credentials and licensure, or any appropriate regulatory credentialing requirements and maintains documentation in the database.  
10. Monitors collection of all information received; follow up on missing items and/or incomplete forms, submit follow up requests for verifications as needed.  
11. Ensures that all credentials are current at all times.  
12. Maintains all credential files ensuring that all correspondence in the credentialing process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements.  
13. Maintains clinic information and practice locations with payers.  
14. Provides optimal customer service to meet the organization’s expectations.  
15. Provides support to executive management in relation to credentialing.  
16. Assists in maintaining payer portals, information, and billing systems.  
17. Keeps current with trends and developments related to essential job competencies, and demonstrates continuous growth.  
18. Performs other duties and works on special projects as requested. 

General Competencies/Performance Expectations:

• Utilizes information technology systems and software applications effectively and in accordance with organizational standards and security protocols. 
• Demonstrates sound judgment by analyzing information thoroughly, reaching timely conclusions, and taking appropriate, decisive action. 
• Plans, prioritizes, and organizes work to ensure maximum efficiency, productivity, and quality outcomes. 
• Actively seeks and utilizes supervision and feedback appropriately to support professional growth and effective job performance. 
• Manages time and utilizes leave in accordance with organizational policies and procedures. 
• Performs additional duties and responsibilities as assigned to support departmental and organizational needs. 

Working Conditions :    

• Office-based position. 
• Travel expectations: driving their own vehicle for work. 
• Exposure to confidential information. 
• Potential exposure to behavioral, crisis and environmental situations. 
• This position is non-union. 

About Harbor:

• A leading provider of mental health and substance use treatment for  over 100 years.
• 350+ clinical staff  serve over 24,000 clients  across multiple locations and in the community each year.
• Services ranging from counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, vocational program, and more!

Why Work for Harbor?

You will have the opportunity to meet other motivated individuals who are also making a positive impact at our company. Harbor is committed to investing our resources in you! Some benefits of working with Harbor include:     

• Medical, dental, and vision coverage
• Retirement plan with company match
• Generous paid time off, sick time, and paid holidays
• Tuition and professional license reimbursement programs
• Clinical supervision hours offered
• Ability to make a difference in your community!