Credentialing Specialist

Position Summary:

The Credentialing Specialist verifies and ensures that providers are properly licensed, certified, or registered as set forth by the State of Washington and credentials, re-credentials, and enrolls providers with commercial insurance, managed care organizations, and any other identified plan. This position also supports internship programs throughout the agency.

Responsibilities:

Credentialing

• Ensures the agency is fully compliant with all state and federal regulations. Keeps up to date on state and federal regulations, policies and procedures
• Creates and maintains all licensing, credentials, and insurance records for providers and agency affiliated insurances.
• Monitors licensing and credential expiration dates and advises staff members of required renewal dates
• Verifies credentials, reviews and confirms that providers have the required background checks
• Completes the National Practitioner Data Bank (NPDB) report
• Coordinates and manages the CAQH Provider Data Portal and assists licensed providers with uploading required data. Confirms or completes quarterly attestations
• Coordinates and completes provider enrollments with insurances, including Medicaid, Medicare as determined per license, and any other agency affiliated insurance
• Monitors and verifies the credentialing process to ensure all required data is accurate and complaint for delegated credentialing. Resolves issues as needed to assure accuracy and compliance
• Completes credentialing and re-credentialing applications for insurances that the agency is affiliated with.
• Maintains and assists the Client Services Manager with agency location information that confirms credentialed and enrolled providers with insurances to ensure accurate billing
• Notifies IT of new provider licenses, license renewals, name, and/or education changes required in the Behavioral Health information system.
• Maintains agency and provider data in websites related to and required for credentialing activities.
• Verifies annual renewal of agency professional liability insurance and uploads or submits to insurances on behalf of providers in the agency.
• Leads the application and/or renewal process for the agency with HRSA, Washington Health Corps, and other entities as indicated/requested.

Agency Internship Program

• In partnership with Recruiting, implements agency internship programs
• Develops and implements internship policies and procedures
• Works with agency departments to understand their internship requirements
• Screens potential interns, assesses intern interest, identifies potential site supervisors, and matches interns to appropriate opportunities
• Coordinates interns' attendance at agency onboarding sessions
• Monitors internships and provides updates on upcoming internship completion dates and other pivotal events
• Networks with and promotes internship opportunities to universities and other community partners.
• Organizes and participates in internship fairs and presents information about the agency's internship programs
• Works closely with interns to assess their ongoing interest in the organization and identifies potential future employment opportunities applicable to individual intern's area(s) of interest.

Perform other duties as assigned

Job Requirements:

The following requirements are those that are normally required for performance of this position. Any disabled applicant or incumbent who does not meet one or more of the requirements, but who can perform the essential function of the job (with or without reasonable accommodations) shall be deemed to meet these requirements.

Physical Requirements:

This position normally requires the physical demands of standing, walking, bending, lifting or performing other work requiring low physical exertion, as well as keyboard fingering, talking, hearing and adequate vision on a regular basis to perform the job requirements. These physical demands are required up to 90% of the time.

Non-Physical Requirements:

Education

• High School Graduation or GED required
• Associate degree or bachelor's degree in healthcare, business, or related field, preferred

Experience

• 3 years' experience in medical or behavioral health administration or as a Credentialing Specialist (or equivalent) required.
• Experience working in Human Resources preferred

Special Skills

• Knowledge of the Washington State Department of Health licensing process, including policies, laws and procedures.
• Ability to research and follow other applicable states' licensing processes
• Proficient with Microsoft Office suite
• Ability to meet strict deadlines and prioritize
• Advanced organization skills
• Proficient with credentialing databases
• High attention to detail and document editing
• Strong interpersonal and written communication skills
• Ability to be self-directed
• Ability to represent the agency in a professional manner within the community

Licensure, Registration, Certification

• Valid Washington State driver's license and minimum required liability insurance for WA State
• Certified Professional Credentialing Specialist (CPCS) certification, preferred

Employment is conditional upon:

• Being cleared by criminal background check and fingerprinting when required