The Credentialing Specialist provides timely and accurate completion of all initial and ongoing clinician and facility credentialing applications as directed by the Billing/Authorization Manager and required by agency managed care and program contracts. The Credentialing Specialist accurately maintains data in the electronic health record which reflects clinician credentialing status in order to facilitate correct third-party billing and collections. This position also performs facility contract maintenance as required by site and/or program changes. They ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
Wheeler Clinic fosters positive change in the lives of individuals and families, as well as in communities. We provide cutting-edge human services that address a diverse range of needs and backgrounds, enhance strengths and provide the supports that encourage recovery from challenges for a satisfying life in the community.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Completes all initial and ongoing clinician and facility credentialing and re-credentialing applications as required by agency managed care contracts in a timely and accurate manner.
Monitors for changes in clinical staff positions, credentials, and/or demographics as they may trigger the need for initial credentialing or communication with managed care companies.
Accurately maintains clinician credentialing status and related data in the electronic health record in order to facilitate correct third-party billing and collections.
Carries out formal communications with managed care companies and performs facility contract maintenance as may be required regarding program, site and/or license additions/changes.
Provides effective and professional customer service via telephone, written and face-to-face interactions with managed care representatives and agency staff seeking information regarding staff credentialing, and coordinates effectively with the Billing Department, Human Resources, IT, Access Center, clinical staff, and supervisors as needed.
Ensures the confidentiality of all client-identifying information, personal staff information, and proprietary business information in accordance with State and Federal regulations, agency polices, and set procedures.
Utilizes the electronic health record and other available technologies and reports to carry out, track, and streamline daily tasks.
Securely maintains accurate and complete clinician and facility credentialing files in accordance with set retention and security guidelines.