Credentialing Specialist

Inactive - Acadia Healthcare Corporate•Franklin, TN

11d•Hybrid

About The Position

The Credentialing Specialist supports and guides assigned facilities through the credentialing portion of the managed care and contracting process. The role partners with facilities to prepare appropriate documentation for submission by required deadlines and reviews paperwork for Medicare, Medicaid, and commercial payer compliance. The specialist maintains departmental workflow to ensure tasks are accurate and completed on time. This is an individual-contributor position based in Franklin, Tennessee, with a hybrid work arrangement.

Requirements

One to three years of healthcare experience.
Basic to working knowledge of managed care concepts.
Documentation proficiency, attention to detail, and organizational skills.
Excellent written communication skills and the ability to summarize concisely.
Ability to handle sensitive and proprietary data professionally while maintaining confidentiality.
Excellent interpersonal skills and ability to interact effectively and professionally with people at all levels, internally and externally.
Sound judgment when responding to inquiries, including knowing when to route inquiries to the next level.
Self-motivation and strong organizational skills with superior attention to detail.
Ability to manage multiple tasks or projects simultaneously within inflexible time frames and adapt to frequent priority changes.
Ability to work within established organizational policies, procedures, and practices.

Nice To Haves

A BA/BS degree is preferred but not required.

Responsibilities

Assist with preparing applications for physician and facility participation in payer programs, including Medicare 855A, 855B, 855I, and 855R, as well as similar Medicaid and managed care plan applications.
Track and monitor facility entries in Medicare’s PECOS database.
Assist facility credentialing leads with preparing Disclosure of Information documents requiring corporate validation and signature.
Prepare and submit initial state Medicaid enrollments and revalidations.
Prepare and administer facility information on the NPPES website, including initial NPIs for new facilities, edits to existing NPIs, and Group NPIs for physician billing.
Work with the Corporate Director of Managed Care to improve process efficiency and create workflow tools as needed.
Perform other duties as assigned.
Comply with organizational policies, procedures, performance-improvement initiatives, and confidentiality policies.
Communicate clearly and effectively with stakeholders and develop cooperative working relationships.
Maintain regular and predictable attendance.