Credentialing Specialist

Workplace Options•Birmingham, AL

19h

About The Position

Workplace Options is proud to support our sister organisation, Behavioral Health Systems (BHS), in recruiting a Provider Relations Credentialling Specialist. This is an exciting opportunity to contribute to a growing organization, ensuring strong provider partnerships and the highest credentialling standards. BHS operates one of the nation’s largest specialty preferred provider organizations (PPO), which is comprised of psychiatrists, psychologists, social workers, EAP providers as well as facility networks including hospitals, rehab/residential treatment centers, partial hospitalization programs and intensive outpatient programs. BHS fully credentials and panels their own network of providers. Current Opportunity: Provider Relations Credentialing Specialist Location: Alabama (Birmingham) Full-time/Part-time: This is a full-time (40 hours per week) position.

Requirements

High school diploma, some college preferred
3 years extensive data entry experience
Minimum 60 WPM typing
Proficiency in MS Word and Access required
Advanced PC computer software skills (i.e., spread sheets, special programs)
Accuracy and attention to detail
Excellent proofreading skills
Good organization and written communication skills
Ability to meet deadlines/handle interruptions/problem-solve
Cooperative attitude and self-starter
Superior disposition and telephone communication skills
Dependability and punctuality
Ability to work with a minimum of supervision
Alabama driver’s license and dependable transportation
Provider credentialing or provider systems experience (or related provider relations experience) required

Responsibilities

Serve as liaison for providers in (re)credentialing process. Assist in resolving problems on a timely basis.
Initiate (re)credentialing process upon receipt of application. Review provider and primary source responses. Refer all responses not meeting BHS credentialing criteria to Director, Credentialing.
Perform National Practitioner Data Bank queries and internet state licensure board verifications.
Maintain computerized provider system, including preparing data conversions for network providers, and entering current credentialing/quality assurance information.
Verify and update provider information upon request or receipt of incorrect provider claim(s).
Assist in preparation and set-up of Provider Relations meetings and panels.
Prepare reports as requested.
Attend quarterly credentialing committee meetings, as requested.
Maintain all information in a confidential manner.
Adhere to established policies and procedures as directed.
Perform other related duties and special projects as directed.