Credentialing Specialist

Acorn Health•Annapolis, MD

1d•$20 - $23

About The Position

Acorn Health is an Applied Behavioral Analysis (ABA) treatment provider dedicated to providing the best quality care for our clients. We aim to continually establish best-in-class standards in integrity and quality for not only ourselves, but also in the field of ABA. We work courageously and with accountability to focus on the individuality of each child, collaborate with client families, and generate permanence in client outcomes. We strive to hire and to invest in our greatest asset - our employees, who are the heart of Acorn Health. Acorn Health is a standard-setting family of ABA treatment providers. We believe the best employees want to work with companies who share their beliefs, and that is true for families who entrust us with children they love. Every day and every interaction, we strive to demonstrate our Five Core Values. As a Credentialing Specialist, you are responsible to process credentialing and re-credentialing files in accordance with Company and departmental policies and procedures and in compliance with state, federal laws and regulations and accrediting organization standards. You are key to ensuring the organization gets paid.

Requirements

Excellent verbal and written communication skills in a virtual environment such as over the phone, email and video calls.
Excellent interpersonal and customer service skills to resolve issues.
Excellent organizational skills and thrives in paying attention to details in high volume atmosphere.
Excellent time management skills with a proven ability to meet deadlines.
Strong analytical and problem-solving skills.
Successful demonstration of leadership skills.
Ability to prioritize tasks and to delegate them when appropriate.
Proficient with Microsoft Office Suite or related software.
High school diploma or equivalent.
At least two years related experience in credentialing experience in healthcare environment.

Responsibilities

Assures the confidentiality and integrity of all aspects of the credentialing program and process including communication of information regarding participating providers to other internal departments.
Builds file documentation and prepares file for credentialing committee review.
Conduct thorough research, establish contacts, and gather pertinent application documents per payor utilizing NCQA standards within state and federal guidelines
Ensure timely OIG verification/re-verification to prevent any negative impact related to compliance or regulatory requirements.
Enter Acorn Health practice information and liability coverage into provider’s CAQH Proview’s file.
Conduct National Practitioner Data Bank and National Student Clearinghouse prime source verification for applicable providers.
Maintain credentialing Smartsheet and Central Reach profiles for providers as assigned
Maintain timely communication with external providers regarding eligibility, supporting documentation, and credentialing and/or related provider issues.
Upload credentialing welcome letters for providers, advise the clinical team of approval, and update provider Central Reach profile.
Refers non-approved providers or questionable situations to senior management.
Assists in researching pended and probated applications and resolving discrepancies.
Performs other related duties as assigned.