- Stay updated with regulatory developments in Behavioral Health, Primary Care, and Medical Staff Services industries.
- Ensure compliance with regulatory and accrediting bodies.
- Collaborate with leadership to develop and implement credentialing processes and procedures.
- Credential physicians, allied health professionals, and other practitioners.
- Panel facilities, physicians, allied health professionals, and other practitioners with insurance providers.
- Maintain accurate practitioner database and analyze verification information.
- Collect and maintain records of licenses, credentials, and insurance contracts.
- Monitor Partner/Customers providers credentials and licenses.
- Advise Partners/Customers on renewal procedures and ensure timely completion of credentialing processes.
- Release information to agencies and the public as required by law.
- Escalate identified credentialing risks to Billing Manager and Partner/Customer leadership.
- Develop and maintain credentialing processes and standards for the department.
- Stay updated on credentialing requirements for Joint Commissions and CARF.
- Stay informed about insurance paneling requirements for Medicare, Medicaid, and Commercial payers.
- Assist in the development and operations of a customer call center.
- Provide credentialing consultations and trainings upon request.
Qualifications :
- Proven experience in provider credentialing and insurance paneling.
- At least 3-5 years of experience in provider credentialing and insurance paneling.
- In-depth knowledge of industry standards and regulations.
- Certification as a Certified Provider Credentialing Specialist through NAMSS preferred.
Knowledge, Skills, and Abilities :
- Ability to understand and address the credentialing requirements of Partners.
- Excellent communication and organizational skills.
- Ability to manage concurrent projects, constituents, and priorities with tight deadlines in a dynamic environment.
- Build positive and effective relationships with internal and external stakeholders.
- Regarded as a team player, modeling company values and culture.
- Ensures all work aligns with company mission and goals.
- Represents the company, mission, and values effectively to both internal and external stakeholders.
