Credentialing Specialist

Harbor • Toledo, OH

5d • Onsite

About The Position

Harbor is seeking a Credentialing Specialist to join its Toledo team. This full-time, 40-hour-per-week, office-based position supports the day-to-day credentialing operations for new and established health care providers and maintains clinical information and practice locations with payer sources in a timely and complete manner. The specialist assists the Credentialing Coordinator, providers, clinical staff, executive management, and other Harbor units with credentialing, privileging, enrollment, renewals, payer information, and related administrative processes.

The role involves maintaining credentialing information in the National Database and SmartCare, entering and validating data, tracking required materials and verifications, following up on incomplete submissions, maintaining credential files and correspondence, and ensuring credentials remain current. The specialist also supports payer portals and billing systems, provides technical and customer support, and keeps current with relevant credentialing processes and legal and regulatory requirements.

Harbor is a mental health and substance use treatment provider with more than 100 years of service. Its 350+ clinical staff serve over 24,000 clients each year across multiple locations and in the community, with services including counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, and vocational programs. The position requires driving the employee's own vehicle for work and may involve exposure to confidential information and behavioral, crisis, and environmental situations. The position is non-union.

Requirements

• High school diploma or GED required.
• Knowledge of medical terminology.
• At least two years of related experience.
• Excellent verbal and written communication skills.
• Ability to meet deadlines in a multifunctional task environment.
• Excellent organizational skills.
• Operational knowledge of word processing, spreadsheets, data entry, electronic health record systems, practice management systems, and other computer-related skills.
• Ability to maintain efficiency and timeliness in daily activities.
• Ability to establish daily work priorities and work efficiently to support the credentialing process.
• Ability to provide customer service consistent with organizational expectations.
• Ability to maintain the confidentiality of privileged information.
• Excellent project management skills, including following up on projects and meeting deadlines.
• Ability to drive a personal vehicle for work.
• Ability to use information technology systems and software in accordance with organizational standards and security protocols.

Nice To Haves

• Associate degree in administration, a health field, or a behavioral science field.
• Behavioral health experience.

Responsibilities

• Assist the Credentialing Coordinator with day-to-day operations.
• Perform credentialing and privileging processes for new and established health care providers in a timely and complete manner.
• Help new staff obtain their NPI and understand the sequential steps in the credentialing enrollment process through completion.
• Provide third-party technical support to Harbor staff working under contract with managed care or insurance organizations and to other Harbor units.
• Assist clinical staff in completing credentialing information.
• Maintain credentialing information in the National Database and SmartCare.
• Coordinate with physicians, facility staff, professional staff, physician office staff, hospital staff, and others to obtain required materials and information.
• Enter data into the database to ensure consistency and integrity.
• Process queries and assist providers with renewing expired credentials and licensure or meeting other regulatory credentialing requirements; maintain supporting documentation in the database.
• Monitor incoming information, follow up on missing items or incomplete forms, and request verifications as needed.
• Ensure credentials are current at all times.
• Maintain credential files and accurately file correspondence; stay current on credentialing processes and legal and regulatory requirements.
• Maintain clinic information and practice locations with payers.
• Provide customer service consistent with organizational expectations.
• Support executive management on credentialing matters.
• Assist with maintaining payer portals, information, and billing systems.
• Keep current with trends and developments related to essential job competencies and demonstrate continuous growth.
• Perform other duties and special projects as requested.
• Use information technology systems and software effectively and according to organizational standards and security protocols.
• Analyze information, exercise sound judgment, reach timely conclusions, and take appropriate action.
• Plan, prioritize, and organize work to support efficiency, productivity, and quality outcomes.
• Seek and use supervision and feedback appropriately.
• Manage time and use leave in accordance with organizational policies and procedures.
• Perform additional duties and responsibilities as assigned to support departmental and organizational needs.

Benefits

• Medical, dental, and vision coverage.
• Retirement plan with company match.
• Generous paid time off, sick time, and paid holidays.
• Tuition and professional license reimbursement programs.
• Clinical supervision hours offered.
• Opportunity to make a difference in the community.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED