Lead Credentialing Specialist

BEACON BEHAVIORAL SUPPORT SERVICES•Plano, TX

14d•Onsite

About The Position

Beacon Behavioral Partners is looking for a Lead Credentialing Specialist to join our team.  This full-time position has the opportunity to work with our Revenue Cycle Team at the opportunity to work onsite at our corporate office located in Plano, TX. We are a growing network of physician-driven psychiatric practices with over 25 years of management experience within the behavioral health industry. Committed to reducing the barriers and burdens that come with owning private practice, Beacon fully manages administrative responsibilities while allowing practices to maintain clinical autonomy. This approach allows physicians to focus on what they do best – taking care of patients.   Beacon Behavioral Partners now guides practices across Louisiana, Arkansas, Mississippi, Florida, Texas and multiple other states across the US. Beacon Behavioral Partners leverage access to an expansive network of over 1000 staff members, including psychiatrists, psychologists, nurse practitioners, mental health therapists and recreational therapists at the forefront of the industry. Its experienced and forward-thinking physician advisory board provides clinicians with a supportive community for building best practices and sharing insights for an enhanced patient experience.

Requirements

Bachelor's degree in healthcare administration, business administration, or a related field preferred.
Minimum of 3 years of experience in provider enrollment and credentialing.
Extensive knowledge of provider enrollment regulations and guidelines, including Medicare, Medicaid, and commercial payer requirements.
Strong understanding of credentialing processes and best practices.
Experience with various payer enrollment portals and systems.
Excellent communication, interpersonal, and organizational skills.
Ability to manage multiple projects simultaneously and meet deadlines.
Detail-oriented and highly accurate.
Strong analytical and problem-solving skills.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) certification preferred.

Responsibilities

Responsible for Compiling and maintaining current and accurate data for all providers
Responsible for Data entry and maintaining provider information in online credentialing databases and system (Credential My Doc, CAQH, PECOS, NPPES, and SharePoint)
Responsible for primary source verification of State license, DEA, and Board certification
Responsible for completing provider initial and re-credentialing applications
Audits applications for accuracy and completeness
Responsible for revalidation requests issued by all payers
Responsible for submitting completed credentialing application and supporting documentation to all requested payers
Responsible for monitoring application progress and following up with payers as needed until confirmation of “in network” status has been received
Responsible for maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. As well as tracking all state license, DEA, and board certification expirations for all providers to ensure timely renewals
Responsible for tracking CME and, sending quarterly updates to providers
Utilizes strong research skills to gather pertinent information regarding providers
And all other duties as assigned
Maintain billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
Maintain practitioner electronic file by keeping all applications/licensures current.
Collects and validates documents to ensure accuracy of all credentialing elements.
Assists in training and monitoring of credentialing specialists, assign work and review for accuracy.
Assist in streamlining credentialing process, onboarding and offboarding for providers and new centers.
Escalate any personnel issues to Credentialing Supervisor
Report and/or escalate provide enrollment issues to RCM leadership.