Privileging & Credentialing Specialist

Easterseals MORC is hiring for a Privileging & Credentialing Specialist to help make a difference and become part of something bigger than yourself! While this position is mostly remote, it does come to our Clinton Township office and requires the successful candidate to reside in the state of Michigan.

We are looking for Game Changers !

The types of people who wake up excited to make a difference. The superheroes of their field who care about the people they serve. If that sounds like you, we want you on our team.

Benefits of Being a Superhero!

Benefits:

• Low-cost Dental/Health/Vision insurance
• Dependent care reimbursement, and up to 5 days paid FMLA for maternity, paternity, foster care and adoption.
• Generous 401K retirement plan
• Paid Leave Options Available
• Up to $125 bonus for taking 5 days off in a row.
• 10 paid holidays and 3 floating holidays (Over 30 days total of paid time off)
• Wellness Programs
• We are a PSLF (Public Service Loan Forgiveness) Employer.
• We provide bonuses and extra incentives to reward hard work & dedication.
• Mileage reimbursement in accordance with IRS rate.
• Free financial planning services through our partnerships with the LoVasco Consulting Group, and SoFi.
• Student loan repayment options
• Pet Insurance

Qualifications:

• Associates Degree in Business Administration or related field
• Five years of experience in a clinic, business, or medical staff office preferred
• Three years of credentialing and provider enrollment experience preferred

Duties and Responsibilities:

1. Processes initial credentialing, privileging, re-credentialing and re-privileging applications of behavioral health care providers for internal staff and external independently contracted clinicians.

2. Responsible for coordination and processing of provider enrollment applications and supporting documentation for third-party payer enrollment and re-enrollment for insurance credentialing for both internal and external staff.

3. Follows up on the status of applications and tracks progress on all pending applications.

4. Maintains the provider files and reports, which include provider demographics, correspondence with insurance plans, status of applications and pertinent licenses and certifications.

5. Works with providers (internal and external) in person, by phone, or email to obtain provider privileging and credentialing and insurance enrollment forms and all supporting documentation.

6. Maintains current and accurate data needed for the credentialing and re-credentialing process for all providers.

7. Prepares credentials file for completion and presentation to privileging committee.

8. Utilizes the credentialing database and performs query, report and document generation; submits and retrieves National Practitioner Data Bank reports in accordance with FTCA and HRSA requirements.

9. Conducts thorough background investigation, research and primary and secondary source verification of all components of the application file per FTCA and HRSA requirements.

10. Identifies issues requiring additional investigation and evaluation; validate discrepancies and ensure appropriate follow up.

11. Maintains and track copies of current state licenses, certifications, malpractice coverage and any other required credentialing documents for all providers.

12. Responds to inquiries from payer organizations regarding credentialing and privileging issues as they arise.

13. Maintains Credentialing and Privileging data related to Independently Contracted Providers for submission to privileging committee every two years or less, as set by the current credentialing/privileging policies.

14. Works with HR specialists, contracting departments, network management and provider representatives to assist in a timely enrollment process, providing additional information as required by the individual plan.

15. Follows up with providers to ensure that all necessary information is received and that the enrollment process is completed timely.

16. Performs follow up with insurance plans to resolve provider enrollment issues and obtain provider participation status.

17. Performs tracking and follow up to ensure provider enrollments are approved and linked to the appropriate group entity and location in a timely manner.

18. Maintains documentation and reporting regarding provider enrollments in process.

19. Maintains up-to-date insurance files with applications, acceptance letters, provider numbers and completed provider enrollments.

20. Retains detailed and accurate lists of insurance plans in which providers participate and their effective dates with each plan.

21. Communicates with providers and staff members regarding each provider’s participation status in insurance plans.

22. Sends updated list of providers and their effective status with insurance plans regularly to staff as needed.

23. Notifies insurance plan representatives of a provider’s change in status or when a provider leaves agency.

24. Re-credentials providers as required by individual insurance plans.

25. Scans provider documents and store electronically in provider database.

26. Completes quarterly updated demographics information to Managed Care Insurances per CMS requirements.

27. Performs other duties as assigned.