Credentialing Specialist

JOB TITLE: CREDENTIALING SPECIALIST

DEPARTMENT: Administrative

SUPERVISOR: CEO

EXEMPT/NON-EXEMPT: Non-Exempt/Full-time

SUPERVISES: None

JOB SUMMARY:

The certified Credentialing and Records Management Specialist must be goal oriented, revenue driven, highly accurate, and motivated. Primary duties include, but are not limited to: 

•  Maintain Excel spreadsheet related to all insurance contracts, staff credentials and whether credentialed or pending status to include preparing and maintaining reports of credentialing activities such as accreditation, membership, or facility privileges.
•  Ensure all information meets federal and state guidelines when processing applications; Report weekly by email to Practice Manager, the Excel spreadsheet of credentialed providers in progress.
•  Provide all necessary documentation completion and management for credentialing WBH providers at all locations; provide contract review, guidance, and administration support.
•  Coordinate the preparation and revision of contracts in alignment with WAC and RCW changes impacting WBH credentialing and revenue cycle management; track and assist contract progress, correspondence, and re-versioning.
•  Assess contract exposures to identify the need for management/legal exclusion. 
•  Secondary duties include timely execution of records requests as set forth in WAC and RCW guidelines, proper scanning of paper documents to electronic health records, record retention revision, monitoring and updating records to ensure proper retention rules are followed and documents are destroyed appropriately.

GENERAL RESPONSIBILITIES:

Follow Willapa Behavioral Health & Wellness Service Excellence Standards / Code of Ethics and Policies and Procedures

1. Adhere to rules of confidentiality.
2. Respect and accommodate a diverse population.
3. Maintain appropriate boundaries with clients and staff.
4. Work on-site as necessary or remotely using telehealth technology as determined by management.

ESSENTIAL FUNCTIONS:

1. Assists with negotiating professional rates and contract terms with both new and contracted providers in conjunction with CEO and CFO. Process applications and reappointment paperwork, checking for completeness and accuracy. Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. 
2. Obtain certified Credentialing and Records Management Specialist (CRMS) through WAMSS within one (1) year from date of signature on this job description.
3. Work closely with Practice Manager and Senior Leadership and other staff to assure client performance guarantees related to network access, effectiveness and efficiencies are met for credentialing and coding and billing purposes and other related agency operations to maximize profitability within industry ethical guidelines.
4. Ensure all new and current providers (MH Therapists, MH Case Managers, SUD counselors, Prescribers, Primary Care Providers) are credentialed with WBH within 60 days of the hire, prior to onboarding a new provider to a WBH Team in working closely with the CHRO to ensure maximum revenue and minimized financial loss.
5. Maintain current credentialing database/spreadsheet for all WBH providers/clinicians specific to each WBH office location. (MCO Roster). Ensure weekly emailed update to full leadership team on status of all new and existing providers credentialed with insurance companies. Onboarding new providers will require at least 60 days advanced credentialing, so the clinician is able to bill once onboarded to that individual’s team.
6. Provide general support to all network development activities and support WBH Executive Team with implementation requirements per each contract’s guidelines. Ensure WBH maximizes profitability with credentialing and billing and coding with each MCO/health insurance company through current contract.
7. Assist team members and offer suggestions to improve company profitability, processes, culture, or work environment. 
8. Participate in and assist with audits to gather needed information or process requests for chart audits.
9. Respond to inquiries from provider offices and various internal departments in a timely and accurate professional manner.
10. Make inquires to other stakeholders on the accuracy of the information, as needed. Follow- up on pending requests when necessary.
11. Functions as back up to front desk receptionists. Enter Requests for Service, entering admits/client packets, managing program transfers, entering discharges. Assists with AVATAR and CREDIBLE EMRs with cleaning up errors and other reports. Requests authorizations for program services between Mental Health, Substance Use Disorders, WISe and other programs. Print records requests. Assists with additional Credible scrubber reports. Function as back-up for creating new employee and contractor Credible accounts. Filing and keeping records management and storage areas with labeling and discarding of paper charts in accordance with agency policy and HIPAA and 42 CFR Part 2 laws.

JOB REQUIREMENTS:

MINIMUM QUALIFICATIONS:

1. High school graduate or equivalent.
2. Experience working in a medical or mental health office.
3. Knowledge of medical terminology.
4. Experience operating office machines; copier, fax, telephone, computer, and calculator.
5. Minimum three years’ experience as a receptionist in an office setting. 
6. Ability to use appropriate reference material effectively, e.g., internet research, instruction manuals, standard dictionary.
7. Excellent verbal and written communication skills, computer proficiency to document in the electronic medical record (EMR) and utilize telehealth and Microsoft office suite. 
8. Undergo and pass criminal background check upon initial employment and any subsequent checks required by the agency.
9. Meet requirements of agency’s drug free workplace policy.
10. Excellent customer service with a client focus.
11. Able to sit, stand and move for long hours at a time and lift up to 25 pounds.
12. A valid driver’s license and reliable vehicle.
13. Able to drive in daylight, darkness, and typical Northwest weather conditions.
14. Flexible to fill-in shifts if needed. 
15. Meet the current Washington health care vaccination requirements for health care workers.

PREFERRED QUALIFICATIONS

1. 2 years experience with Provider Credentialing 
2. Certification in Health Information Management

PAY RATE

$28.28 plus pro-rated benefits