Credentialing Specialist

About This Role

This Credentialing Specialist role involves ensuring compliance with regulatory and accrediting bodies in the behavioral health, primary care, and medical staff services industries. The specialist will work with leadership to develop and implement credentialing processes and procedures, and manage the credentialing and insurance paneling for various practitioners and facilities. The role suits a candidate with subject matter expertise in provider credentialing and a commitment to maintaining accurate records and advising partners on renewal procedures.

Responsibilities

• Keep abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industries
• Maintain compliance with regulatory and accrediting bodies
• Work collaboratively with leadership in the development and implementation of credentialing processes and procedures
• Credential physicians, allied health, and other practitioners
• Insurance panel facilities, physicians, allied health, and other practitioners
• Collect and maintain an accurate practitioner database and analyze verification information
• Collect and maintain records in licenses, credentials, and insurance contracts
• Monitor Partner/Customer
• Work collaboratively with Partners/Customers to advise on renewal procedures
• Work collaboratively with Partners/Customers to ensure timely completion of credentialing processes
• Release information to agencies and members of the public as required by law
• Escalate identified credentialing risks to Billing Manager and Partner/Customer leadership
• Maintain subject matter expertise level in provider credentialing and processes
• Develop and maintain credentialing processes and standards for the department
• Keep abreast of credentialing requirements for Joint Commissions and CARF
• Keep abreast of insurance paneling requirements for Medicare, Medicaid, and Commercial payers
• Assist with the development and operations of a customer call center
• Provide credentialing consultations/trainings as requested

Requirements

• Proven experience in provider credentialing and insurance paneling
• In-depth knowledge of industry
• Ability to delve into the credentialing requirements of Partners
• Excellent communication and organizational skills
• Motivation and ability to manage concurrent projects, constituents, and priorities with tight deadlines in a dynamic environment
• Build positive and effective relationships with other leaders, internally and externally
• Regarded as a team player by colleagues and models company values and culture