Credentialing SpecialistCommunity Health Center of Snohomish County
The Credentialing Specialist coordinates all aspects of the payer credentialing process for licensed providers. Processes applications, verifies information, researches application discrepancies, and assures process is in accordance with payer requirements and completed timely.
Knowledge, Skills & Abilities
• Reads, speaks, understands and writes proficiently in English.
• Effectively communicates orally and in writing.
• Strong analytical, attention to detail, and problem solving skills.
• Independent and self-directed.
• Works effectively in a team environment.
• Problem-solves with creativity and ingenuity.
• Organizes, prioritizes, and coordinates multiple activities and tasks.
• Works with initiative, energy and effectiveness in a fast-paced environment.
• Produces work in high quantity and quality.
• Remains calm and effective in high pressure and emergency situations.
• Use of multi-line telephones and other office machines.
• Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.
• High school graduate or equivalent.
• Graduate of an accredited Office Skills Certification Program or related field.
• Graduate of an accredited Medical Administrative Assistant Certification program or related field.
• Working with insurance/billing in a healthcare setting/insurance organization (3 years).
• Clerical, reception and billing or other administrative experience in a healthcare setting or healthcare insurance organization (3 years).
• Customer service related experience working with the general public (1 year).
• Data entry experience (1 year).
• Provider payer credentialing processes.
• Working with private and/or government third party reimbursement.
• Healthcare information systems, such as electronic practice management systems experience.
• Working with low income, multi-ethnic populations.
• Certified Provider Credentialing Specialist (CPCS).
Job Specific Functions/Performance Expectations:
1. Develop and implement systems and procedures related to all enrollment and credentialing processes.
2. Coordinate the completion and submission of commercial, managed care and government insurance credentialing and re-credentialing applications, reports progress to Patient Accounts staff.
3. Manage and monitor the status of provider credentialing/re-credentialing applications submitted to payers, follow up as needed.
4. Set up and maintains provider information in internal and external tracking systems (i.e. Provider One, Provider Source, CAQH, NPI, etc.).
5. Monitor payer credentialing/re-credentialing processes for all licensed providers, including updating various spreadsheets and internal credentialing workflows as needed.
6. Adheres to quality and quantity standards of the department, which includes but is not limited to a minimum of 97% accuracy on quality of work.
7. Be a resource and act as primary point of contact for managers, providers, staff and payers on day to day issues related to credentialing and enrollment, troubleshooting issues as they arise.
8. Communicate and verify accuracy of insurance information/provider numbers to Patient Accounts staff.
9. Notify health plans of physician practice status (i.e. open vs. closed practice).
10. Audit insurance company directories for current and accurate provider information.
11. Respond to manager, practitioner and payers inquiries in a timely and responsive manner.
12. Adheres to the department’s standards of personal phone use.
13. Adheres to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care.
We offer competitive salary and a comprehensive benefits package designed to address health, time off, retirement and career-advancement needs. We also offer an additional $0.75/hour for those who test proficiently in a second language.
To learn more and to apply for this position, please visit our website www.CHCsno.org to complete an online application and/or submit your resume for consideration.
Join a team that loves what they do and cares about those they serve.