Behavioral Health Credentialing Specialist
Overview:
The Behavioral Health Credentialing Specialist is responsible for overseeing the credentialing and re-credentialing of all providers for both commercial and government payers, ensuring that all providers maintain active status. This role involves managing provider information, overseeing the credentialing process, negotiating fee schedules, and ensuring compliance with all relevant regulations and standards.
Essential Duties and Responsibilities:
• Credentialing & Re-Credentialing:
• Initiate and manage the credentialing and re-credentialing process for individual providers and provider groups with all payers, including government and commercial plans.
• Oversee end-to-end credentialing of new and existing providers, ensuring all necessary applications and supporting documentation are accurate and complete.
• Maintain up-to-date provider files for credentialing purposes, including state licenses, DEA registrations, and controlled substance registrations.
• Leverage in-depth knowledge of the services provided and the corresponding CPT codes for billing to establish a strong foundation for credentialing expectations.
• Provider Information Management:
• Set up and maintain provider information in online enrollment systems, health plans, and internal databases.
• Oversee the screening of practitioners' applications and supporting documentation to ascertain their eligibility.
• Update and maintain provider rosters to ensure current data is accessible.
• Ensure all provider tracking databases are accurate, including CAQH (Council for Affordable Quality Healthcare) profiles.
• Monitor credentialing files and ensure timely renewal of all required certifications and licenses.
• Fee Schedule & Contract Negotiation:
• Update and maintain fee schedules for all payers, ensuring the most optimal rates are obtained.
• Collaborate with executive leadership to negotiate, renegotiate, and manage fee schedules.
• Compliance & Reporting:
• Ensure compliance with applicable laws, regulations, and policies, including state/federal regulations.
• Create reports for executive leadership detailing credentialing updates, issues, and compliance matters.
• Ensure the collection and submission of required documentation for licensing, board certifications, and professional liability insurance.
• Respond to inquiries from health plans and provide timely follow-up on all outstanding credentialing/re-credentialing files.
• Collaborative Agreements:
• Work with leadership to track and maintain Collaborative Agreements between Nurse Practitioners and Physicians, ensuring all necessary documentation is in place.
• Project Management & Tracking:
• Utilize project management tools to track the progress of credentialing and re-credentialing applications.
• Ensure all provider-related information is updated and complete in internal tracking databases.
Required Education and Experience:
• Bachelor’s degree in Healthcare, Business Administration, or related field, or 5+ years of relevant experience.
• 3+ years of credentialing experience in a healthcare or medical staff setting.
• Familiarity with the credentialing process for state, federal, and health plan applications.
• Experience with the CAQH database and application process.
• Knowledge of credentialing standards and regulations.
• Excellent verbal and written communication skills.
• Proficient touch-typing skills and the ability to focus for extended periods.
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The Behavioral Health Credentialing Specialist is responsible for overseeing the credentialing and re-credentialing of all providers for both commercial and government payers, ensuring that all providers maintain active status. This role involves managing provider information, overseeing the credentialing process, negotiating fee schedules, and ensuring compliance with all relevant regulations and standards.
Essential Duties and Responsibilities:
• Credentialing & Re-Credentialing:
• Initiate and manage the credentialing and re-credentialing process for individual providers and provider groups with all payers, including government and commercial plans.
• Oversee end-to-end credentialing of new and existing providers, ensuring all necessary applications and supporting documentation are accurate and complete.
• Maintain up-to-date provider files for credentialing purposes, including state licenses, DEA registrations, and controlled substance registrations.
• Leverage in-depth knowledge of the services provided and the corresponding CPT codes for billing to establish a strong foundation for credentialing expectations.
• Provider Information Management:
• Set up and maintain provider information in online enrollment systems, health plans, and internal databases.
• Oversee the screening of practitioners' applications and supporting documentation to ascertain their eligibility.
• Update and maintain provider rosters to ensure current data is accessible.
• Ensure all provider tracking databases are accurate, including CAQH (Council for Affordable Quality Healthcare) profiles.
• Monitor credentialing files and ensure timely renewal of all required certifications and licenses.
• Fee Schedule & Contract Negotiation:
• Update and maintain fee schedules for all payers, ensuring the most optimal rates are obtained.
• Collaborate with executive leadership to negotiate, renegotiate, and manage fee schedules.
• Compliance & Reporting:
• Ensure compliance with applicable laws, regulations, and policies, including state/federal regulations.
• Create reports for executive leadership detailing credentialing updates, issues, and compliance matters.
• Ensure the collection and submission of required documentation for licensing, board certifications, and professional liability insurance.
• Respond to inquiries from health plans and provide timely follow-up on all outstanding credentialing/re-credentialing files.
• Collaborative Agreements:
• Work with leadership to track and maintain Collaborative Agreements between Nurse Practitioners and Physicians, ensuring all necessary documentation is in place.
• Project Management & Tracking:
• Utilize project management tools to track the progress of credentialing and re-credentialing applications.
• Ensure all provider-related information is updated and complete in internal tracking databases.
Required Education and Experience:
• Bachelor’s degree in Healthcare, Business Administration, or related field, or 5+ years of relevant experience.
• 3+ years of credentialing experience in a healthcare or medical staff setting.
• Familiarity with the credentialing process for state, federal, and health plan applications.
• Experience with the CAQH database and application process.
• Knowledge of credentialing standards and regulations.
• Excellent verbal and written communication skills.
• Proficient touch-typing skills and the ability to focus for extended periods.
Apply Now
Apply Now