Credentialing Assistant

Requisition #: 52071

Status: Full-time, Non-Exempt

Schedule: Monday – Friday, 8AM – 5PM

Onsite or Hybrid: Hybrid - onsite 3 days per week. Will need to conduct orientation/training onsite.

Bilingual (English/Spanish): No

POSITION SUMMARY:

Credentialing Assistant will report to the Credentialing Supervisor Will assist with the daily administrative tasks related to provider credentialing.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Assists with populating credentialing applications for providers to expedite submission to health plans.
• Assists with credentialing applications for new Medical, Behavioral, and Dental provider(s).
• Contacts health plans on a 15–30-day mark to check in on status of credentialing application submissions.
• Assists with uploading all credentialing-related files onto Paycom when received (credentialing approvals, rejections, terminations, recredentials, etc.).
• Inputs effective dates and credentialing status into Paycom.
• Records credentialing-related data in the Health Plan Enrollment spreadsheet including, but not limited to effective & expiration dates, credentialing status information, demographic updates, terminations, etc.
• Notifies Billing & Credentialing work group when all health plan credentialing applications have been submitted & when provider is fully enrolled into all health plans.
• Connect with Clinic Directors on a quarterly basis to confirm provider service locations and schedules. Updates schedule on provider information spreadsheet.
• Verifies with each health plan (phone call, email, roster, etc.) all providers are actively credentialed/enrolled on a quarterly basis.
• Attests portal & directory verifications required by specific health plan accounts/websites.
• Sends training(s) when required from the health plans. Tracks completion of training(s) before due date to ensure provider is being compliant.
• Submits demographic changes for providers when needed (changes in service location, schedule, leave status, name, patient acceptance, etc.).
• Retrieves and uploads current roster from health plan if applicable on a quarterly basis.
• Assists with provider terminations from each health plan when they leave the agency and with updating all tracker sheets.
• CAQH follow-ups and current document uploads (updated licenses, DEAs, insurances).
• OIG Streamline Verify monthly checks for all employees (if we keep this in credentialing).
• Annual NP Protocols/PA Practice agreements.
• Privileging request follow-ups (for those already credentialed and who need to renew).

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

Qualifications

REQUIREMENTS:

Training and Experience:

Must possess an AA degree and have 2 years of credentialing or administrative experience or a High School Diploma and 4 years’ experience. Must be organized, computer savvy and detail oriented. Possess clear and effective oral and written communication skills. Knowledge of health plan enrollment, or prior health care experience preferred.

Knowledge of:

Outlook, Microsoft Word and Microsoft Excel, Paycom (Preferred).

Ability to:

Meet all deadlines, be persistent, strong organizational skills and detail oriented. Work with people of diverse cultural, educational, social and economic backgrounds. Must have willingness to learn process of Credentialing.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer and on paper.

SPECIAL REQUIREMENTS:

COVID-19 Vaccination or Medical/ Religious Exemption required.

Equal Opportunity Employer.