Credentialing and Contracting Specialist

Community Health Center of Southeast Kansas Inc•Pittsburg, KS

61d

About The Position

The Credentialing and Contracting Specialist works under the supervision of the Credentialing and Contracting Manager. The role processes credentials and privileges for providers to verify accuracy and compliance with CHC/SEK policies and procedures, as well as applicable state, federal, Medicare, and Medicaid requirements. The specialist maintains data integrity for credentialing and recredentialing records and supports provider and facility applications to payers for revenue cycle purposes. The position requires protecting confidential credentialing files and information, coordinating provider details needed for billing, and supporting payer enrollment, contracting, and recredentialing. The employee is expected to perform duties in keeping with CHC/SEK’s core values of dignity and stewardship, and to follow organizational policies, procedures, and HIPAA requirements.

Requirements

High school diploma or equivalent.
Computer literacy.
Ability to use the organization’s credentialing software system and electronic medical record proficiently.
Ability to maintain good interpersonal relationships with coworkers and other members of the healthcare team and organization.
Ability to provide customer service in accordance with the organization’s mission.
Ability to communicate through appropriate channels and follow the proper chain of command for patient complaints.
Ability to handle emergency situations calmly and effectively.
Ability to maintain patient confidentiality in accordance with organizational policy and procedure and HIPAA requirements.
Social and cultural sensitivity appropriate to an ethnically and economically diverse patient and employee base.
Ability to be courteous and respectful when interacting with coworkers and people outside the organization.

Nice To Haves

One year of experience in a healthcare office setting.

Responsibilities

Follow CHC/SEK’s Credentialing Policy and Procedure and ensure credentialing processes are completed on time.
Research and verify references and backgrounds for providers before hiring.
Verify providers’ professional credentials, references, claims history, fitness, and professional review organization findings.
Use available resources to verify provider applications, education, licenses, and references through primary source verification in accordance with state and federal guidelines.
Communicate credentialing findings to the supervisor.
Create and maintain provider database information, including CAQH, KMAP, NPPES, NPI, and other required licenses, certifications, or professional memberships.
Maintain accurate, complete, confidential, and secure credentialing files for providers.
Coordinate entry of new provider information, such as DEA details, license numbers, and NPI, into the electronic health record system for billing purposes.
Submit accurate and complete applications to payers to obtain billing numbers for facilities and providers.
Ensure third-party payer contracts are signed by all necessary parties to support plan enrollment.
Maintain basic knowledge of provider and facility credentialing and recredentialing guidelines and payer network participation requirements.
Communicate and document the status of provider and facility payer enrollments with stakeholders.
Complete EFT and ERA enrollment as part of the enrollment process to support electronic payments and claims submissions.
Track providers’ licensing requirements as part of payer enrollment.
Provide accurate, complete, and timely credentialing and privileging information for recredentialing.
Communicate with applicants, employment references, and others as needed to complete credentialing and contracting on time.
Perform duties, services, and documentation in compliance with CHC/SEK policies and procedures.
Perform other duties as assigned.