Credentialing Specialist

Job Description

SUMMARY

The Credentialing Specialist ensures all clinicians are credentialed with the Oklahoma Health Care Authority, Medicare, and other Private Insurance Companies. Assist in keeping Red Rock’s credentialing database maintained, and ensures electronic files are up to date.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Maintains high quality, timely and accurate credentialing processes of healthcare clinicians and continues to build excellent rapport with clinicians and insurance companies

Assists in the credentialing process by entering/logging/scanning information into the credentialing system for initial, updating, and add on applications and maintenance process

Processes and maintains credentialing and re-credentialing in accordance with client facility policy and procedure, Commission on Accreditation of Rehabilitation Facilities (CARF) standards, State and Federal Regulatory regulations

Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow up requests for verifications as needed

Identifies and evaluates potential red flags and works in collaboration with clinician to document the issue and healthcare provider responses

Advises Credentialing Supervisor of questionable information received and any issues identified during the processes

Maintains all credentialing files ensuring that all correspondence in the credentialing and reappointment process is accurately electronically filed; keeps current process and legal/regulatory requirements

Performs other duties as assigned

QUALIFICATIONS

High School Diploma or equivalent; Associates preferred

Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care facility, credentials verification organization, or Medical Staff Office)Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred

Strong problem solving skills, good judgment, attention to detail and follow-through

Experience working with the Oklahoma Health Care Authority is a plus

Ability to maintain confidentiality of privileged information Ability to work independently, productively and well under pressure

Working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred

Commitment to the mission of Red Rock BHS

BENEFITS (Full-Time Staff Only)

95% Employer Paid Health Insurance Plan

Dental Insurance

Vision Insurance

Some Positions Qualify for NHSC Student Loan Repayment

403B Retirement Plan with 5% Employer Contribution

Annual Professional Growth Funds

3 Weeks Paid Time-off

Employer Paid Life Insurance and Long Term Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

Red Rock Behavioral Health Services does not discriminate based on race, color, national origin, religion, gender, gender identity, age, marital/familial status, sexual orientation, or disability.