Credentialing Specialist

Overview

Position Summary:

Coordinates, performs a variety of administrative duties required for provider credentialing and enrollment. Interacts extensively with providers, enrollment staff, insurance plans, HR recruitment, clinical departments and leadership to facilitate provider enrollment, and to maximize reimbursement for services rendered.

Why choose Behavioral Innovations:

• Daily Pay: Access your pay when you need it!
• Wellbeing Program: Equipping you with tools to achieve your wellness goals.
• OVIA Health: A Women's Health App supporting you throughout the entire Parenthood Journey.
• Employee Assistance Program (EAP): Comprehensive support for your mental, emotional, and physical health.
• Supportive Team Structure: Our clients and families are our top priority, and we foster a collaborative and expert team environment.
• Additional Programs Offered at BI: ABA Intern, Referral Bonuses, Employee Recognition, Employee Perks.
• Career Advancement Opportunities: Ongoing training & Professional development for all employees.
• Insurance: Medical, Vision, Dental, and Supplemental Insurance Policies.
• University Partnerships: Enjoy tuition rate discounts.
• Pet Insurance!
  
  
  

Duties & Responsibilities

• Enroll providers with commercial and government payors; and revalidate providers with government and contracted payors.
• Obtain, accurately complete, and submit enrollment applications and related documents to payors.
• Audit payor directories for current and accurate provider information.
• Facilitate payor calls to address contracting and credentialing issues.
• Assure all regulatory requirements are met with commercial payors and state agencies.
• Coordinate enrollment for providers into any out of state Medicaid programs which facilitates reimbursement for BI.
• Prepare all commercial, Medicaid and/or third-party application forms required for credentialing and enrollment purposes for new providers; run reports and manage existing provider accounts for re-credentialing, re-validation and working expirable.
• Familiar with Electronic Medical Records and Billing Systems.
• Perform any other duties assigned
  
  
  

Requirements:

• Associates degree and three (3) years relevant experience in credentialing or related work experience may be substituted in lieu of educational qualifications.
• 1-3 years of knowledge in a behavioral health or medical clinic setting preferred, but not necessary.
• Take the initiative to identify and resolve issues
• Demonstrate resourcefulness and cooperation
• Exhibit BI’s core values in all interactions
• Willing to learn and take on new tasks
• Exhibit high quality work
• Use excellent judgment
• Communicate clearly
  
  
  

CORP2024