Credentialing Specialist-FD513806 chez None

JOB SUMMARY:

Credentialing Specialist healthcare professional authenticates credentials and other relevant documents submitted by individuals, ensuring they meet the necessary standards to practice.  Reviewing and ensuring that healthcare providers are qualified to provide care will troubleshoot denials, maximize revenue through contracting and credentialing service locations and current staff with major MCO’s, both commercial and state for behavioral health services and treatments.  

ESSENTIAL JOB FUNCTIONS:

• Assist in reviewing staff credentials, licenses, certifications, and other relevant documents to ensure they are current and meet regulatory standards.
• Maintain accurate and up-to-date credentialing records in tracking spreadsheets and internal systems.
• Support the provider enrollment process by gathering required documentation and completing applications for submission to Medicaid, Medicare, and major Managed Care Organizations (MCOs).
• Monitor expiration dates for licenses and certifications and send reminders to staff and supervisors as needed.
• Assist in maintaining staff CAQH and NPPES profiles by ensuring accurate and updated information is submitted (taxonomy codes, credentials, etc.).
• Coordinate with HR and program directors to collect onboarding credentialing documentation for new hires.
• Prepare and submit credentialing packets to payers, following up on outstanding items and verifying receipt and status.
• Respond to requests for credential information and verification from payers, programs, and internal departments.
• Track the progress of credentialing applications and maintain spreadsheets reflecting current credentialing and contracting statuses.
• Assist with troubleshooting basic credentialing denials and flag issues to supervisor or appropriate team member for resolution.
• File and organize credentialing documents for easy retrieval and audit readiness.
• Perform other administrative tasks related to credentialing or finance billing as assigned by the Billing manager or Credentialing Lead.

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES:

• Committed to active promotion of ICL values and goals.
• Understanding of the healthcare industry, including knowledge of medical terminology, healthcare regulations, compliance standards, and accreditation requirements.
• Strong organizational and excellent follow-up skills.
• Strong customer service skills, excellent communication -- verbal and written. 
• Ability to communicate with MCO representatives to foster ICL’s commitment to their members.
• Problem solver and strong attention to detail, flexibility, and the ability to adapt to changing work situations and the ability to make good decisions.
• Ability to understand and support the agency’s mission, vision, standards and code of ethical behavior.
• Attention to details and timely completion of task.

QUALIFICATIONS AND EXPERIENCE:

College degree preferred but not required. Experience in healthcare administration, health information management, business administration, or equivalent work experience. Required skills are excel experience, customer service skills, time management and high follow-up abilities.