Credentialing Specialist At 360 Behavioral Health-Z&S Management

DESCRIPTION

The Credentialing Specialist will report directly to the Credentialing Manager. This position is responsible for organizing, creating and maintaining all credentialing files and related reports and coordinating the submission of credentialing applications using data provided by various Company departments. This will include Commercial plans, Regional Centers and School districts. Responsible for maintaining all provider rosters to be submitted to plans. Very faced pace and deadline oriented position.

This position is located in Tarzana, California office and is a full-time hourly (non-exempt) position.

Duties and Responsibilities

• Coordinates, creates, monitors and facilitates the review and analysis of completion of clinician applications and accompanying documents for payers and insurance plans.
• Develops and maintains a working knowledge of the statutes and laws relating to credentialing and seeks clarification from Corporate Legal or Compliance when needed.
• Works with all required agencies to obtain national provider numbers (NPI) for qualified health care providers and new locations.
• Completes insurance applications for providers and facilities; ensures accuracy for submission. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares credential file for presentation to identified agencies, meets deadlines set by state, payer or internal management.
• Able to work within the credentialing software system and/or Excel for document retention by filing and scanning documents and email correspondence.
• Responsible for the accuracy and integrity of the credentialing database system and related applications.
• Identifies, obtains, verifies and updates database with providers’ credentialing information.

• Updates CAQH database with attestations, updating credentialing documents as needed/required.
• Conducts very detailed follow up of credentialing status with the plans and reports monthly progress to leadership
• Represents 360 Behavioral Health in a professional, loyal and ethical manner
• Responds to inquiries from other healthcare organizations, interfaces independently with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Assists with managed care delegated credentialing audits; conducts internal file audits.

Requirements

• 2-4 years of Provider Credentialing Experience with insurance plans, behavioral health experience a plus.
• Certified Provider Credentialing Specialist (CPCS) or comparable certification/experience preferred.
• Considerable knowledge of commercial insurance plan credentialing applications and processes
• Knowledge of CAQH and NPI sites and experience working in both.
• Familiar with NaviNet, Availity and Healthplan website credentialing portals
• Excellent inter-personal relationship skills and the ability to work with individuals at all levels
• Excellent written and verbal communication
• Database management skills including querying, reporting, and document generation. Informational research skills.
• Must have Proficiency in Microsoft Office, specifically Excel
• Able to deliver effective results, meet tight deadlines, and targets
• Team player