Credentialing Specialist

Wingspan Care Group•Shaker Heights, OH

About The Position

The Credentialing Specialist is responsible for assisting providers with maintaining an active status by completing initial and subsequent credentialing activities as required by federal, state and local regulations, contractual obligations and payer credentialing requirements.

Requirements

Education: Bachelor’s Degree preferred. Minimum of High School Diploma with a minimum of 5 years of relevant experience will suffice.
Sensitivity in relating to persons of varying backgrounds and demonstrate ability to work with diverse groups of people possessing various strengths, aptitudes and abilities.
Ability to perform job responsibilities with a high degree of initiative and independent judgment.
Demonstrated oral and written communication skills and effective interpersonal skills.
Proficiency in using Agency computer systems and software as required to perform essential job functions
Practical and creative problem solving skills.
Minimum 3 years administrative experience in an office environment required.
Minimum 1 year Behavioral Health experience required.

Nice To Haves

Minimum 1 year credentialing experience preferred.

Responsibilities

Maintain accurate and up-to-date credentialing records for Agency employees, including meeting with Agency staff at their respective locations to ensure a smooth credentialing process.
Monitor license and credential expiration dates and advise staff members of required licensure “renew by” dates.
Provide direct credentialing support to staff through activities including, but not limited, to assisting staff in obtaining their OH-ID, obtaining and updating their National Provider Identifier (NPI), applying for and maintaining their status as an Ohio Medicaid Provider utilizing the Provider Network Management (PNM) system as well as obtaining and maintaining a Council for Affordable Quality Healthcare (CAQH) Provider Profile.
Partner with Talent Acquisition and act as a point of contact for new Agency employees, ensuring that all staff who need credentialed (i.e., obtain an OH-ID, NPI, Medicaid Provider# and CAQH Provider Profile) have completed the necessary credentialing activities no later than the staff’s first two weeks of employment.
Maintain accurate staff affiliations in PNM, including affiliating new staff during onboarding as well as un-affiliating staff upon Agency termination.
Complete credentialing activities related to commercial payers including, but not limited to, submitting credentialing applications to add providers to insurance panels, communicating with commercial payers to follow-up on status of applications, and responding to re-credentialing requests from commercial payers.
Maintain up-to-date knowledge of regulations and policies related to provider enrollment.
All required trainings, certifications and licensure must be kept current in accordance with applicable licensing and accreditation regulations and standards
Respect the privacy of clients and hold in confidence all information obtained during the client’s treatment. All client-related documents should be handled in accordance with Agency guidelines on confidential material.
Maintain high standards of ethical and professional conduct and adhere to Agency policies and procedures.
Perform other duties as assigned by management.

Benefits

Comprehensive health and Rx plans, including a zero-cost option.
Wellness program including free preventative care
Generous paid time off and holidays
50% tuition reduction at Case Western Reserve University for the MSW program
Defined benefit pension plan
403(b) retirement plan
Pet insurance
Employer paid life insurance and long-term disability
Employee Assistance Program
Support for continuing education and credential renewal
Ancillary benefits including: dental, vision, voluntary life, short term disability, hospital indemnity, accident, critical illness
Flexible Spending Account for Health and Dependent Care