Credentialing Specialist

Job Description

Job Description

SUMMARY

The Credentialing Specialist ensures all clinicians are credentialed with the Oklahoma Health Care Authority, Medicare, and other Private Insurance Companies. Assist in keeping Red Rock’s credentialing database maintained, and ensures electronic files are up to date. 

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Maintains high quality, timely and accurate credentialing processes of healthcare clinicians and continues to build excellent rapport with clinicians and insurance companies
• Assists in the credentialing process by entering/logging/scanning information into the credentialing system for initial, updating, and add on applications and maintenance process
• Processes and maintains credentialing and re-credentialing in accordance with client facility policy and procedure, Commission on Accreditation of Rehabilitation Facilities (CARF) standards, State and Federal Regulatory regulations
• Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow up requests for verifications as needed
• Identifies and evaluates potential red flags and works in collaboration with clinician to document the issue and healthcare provider responses
• Advises Credentialing Supervisor of questionable information received and any issues identified during the processes
• Maintains all credentialing files ensuring that all correspondence in the credentialing and reappointment process is accurately electronically filed; keeps current process and legal/regulatory requirements
• Performs other duties as required

QUALIFICATIONS

• High School Diploma or equivalent; Associates preferred
• Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care facility, credentials verification organization, or Medical Staff Office)Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
• Strong problem solving skills, good judgment, attention to detail and follow-through
• Experience working with the Oklahoma Health Care Authority is a plus
• Ability to maintain confidentiality of privileged information Ability to work independently, productively and well under pressure
• Working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
• Commitment to the mission of Red Rock BHS

PHYSICAL REQUIREMENTS

• Must have the ability to stand or sit for long periods of time
• Must have the ability to lift, push, or pull a minimum of 25 pounds
• Ability to travel approximately 10% of the time
• Ability to use telephone, PC, fax machine, copy machine, and printer

HOW WE TAKE CARE OF YOU!

• We pay a generous portion of your Health Insurance
• Low-cost Dental and Vision Insurance
• Retirement Plan with employer contributions equal to 5% of annual salary
• Student Loan Repayment Options
• No Cost Employee Assistance Plan
• 3 Weeks Paid Time-Off (increases annually between years 2-10)
• 9 Paid Holidays
• 1 Floating Holiday to use at your discretion.
• 4 Rest and Relaxation Days
• 3 days of Education Leave
• 4 hours of Volunteer Leave
• Eligible for Pay Increases and Bonuses Annually
• Employer Paid Long-Term Disability and Life Insurance

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

Red Rock Behavioral Health Services does not discriminate based on race, color, national origin, religion, gender, gender identity, age, marital/familial status, sexual orientation, or disability.