Credentialing Specialist - CBHS

JOB TITLE: Credentialing Specialist


FLSA STATUS: Non-Exempt


PROGRAM: Clinical


HOURS PER WEEK: 40


REPORTING RELATIONSHIP: Care Connections Coordinator


JOB DESCRIPTION:

Under general supervision, coordinates and administers the credentialing process for licensed providers on behalf of a specified practice plan, or third party insurance payer organization, ensuring that all credentialing and accreditation processes and procedures are completed in accordance to established accreditation, regulatory, and policy requirements.

Essential Functions:

· Initiates and coordinates the acquisition and receipt of all credentialing documentation from new and existing providers; provides follow-up and problem resolution as required.

· Coordinates the processing, distribution, and management of all credentialing documents for providers.

· Requests, coordinates, records, and maintains background checks and license verifications in support of all credentialing applications.

· Develops and implements systems and procedures to ensure that all credentialing processes are completed in accordance with relevant regulations, policies and standards.

· Develops and maintains a comprehensive credentialing database and prepares reports and summaries as appropriate; monitors individual profiles.

· Maintains and ensures strict confidentiality of files and databases.

· Schedules, coordinates, and facilitates Credentialing Committee proceedings; provides follow-up and problem resolution regarding committee matters as appropriate.

· Acts as primary point of contact for all internal and external constituencies in all day-to-day administrative matters associated with the credentialing process.

· Troubleshoots and resolves problems and issues as they arise.

· Facilitates and assists with internal and external records audits as appropriate.

· Performs miscellaneous job-related duties as assigned.

REQUIRED KNOWLEDGE AND SKILLS:

· Basic computer knowledge.

· Knowledge of clinical provider credentialing principles, processes, procedures, and documentation.

· Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.

· Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.

· Organizing and coordinating skills.

· Ability to develop and maintain filing systems.

· Skill in the configuration and use of computerized database programs.


QUALIFICATIONS:

· Recent experience as a Credentialing Coordinator.

· Ability to work cooperatively with providers.

· Ability to develop and maintain recordkeeping systems and procedures.

· Skill in the use of personal computers, online activities, and related software applications.

· Knowledge of provider credentialing regulations, policies, guidelines, and standards.

· High school diploma or GED with 5 to 7 years, experience directly related to the duties and responsibilities specified.


Education:

Associate’s or bachelor’s degree preferred or 5-7 years, equivalent experience


This job description in no way states or implies that these are the only job-related duties to be performed by the employee. He or she will be required to follow any other job- related instructions and perform any other job-related duties requested by his or her supervisor.


Please submit resumes to: willnern@cbhsinc.org & santiagoj@cbhsinc.org

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