Credentialing Specialist

JOB TITLE: Credentialing Specialist

LOCATION: Heppner, OR

FLSA: 1.0 FTE (Expectation to work 40 hours a week)

SUPERVISOR: Business Operations Manager

PAY GRADE: B07 ($22.21 – $31.54 per hour, depending on experience)

Apply at: ccswebsite.org/employment/

DESCRIPTION  

The Credentialing Specialist is responsible for overseeing, maintaining, and ensuring active status for all providers by successfully completing initial and subsequent credentialing packages as required. They ensure that the relevant Oregon Administrative Rules (OAR’s) are adhered to, monitor quality assurance, and develops and monitors credentialing protocols for Community Counseling Solutions.  

SUPERVISION

Supervision Received

The Credentialing Specialist works under the direction of the Billing Supervisor.  

Supervision Exercised  

This position has no supervisory responsibilities.  

RESPONSIBILITIES

• Responsible for oversight of credentialing and recredentialing of all clinical and medical staff.  
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.   
• Maintain internal provider grid to ensure all information is accurate and logins are available.   
• Update each provider’s Council for Affordable Quality Healthcare (CAQH) database file timely according to the schedule published by Centers for Medicare & Medicaid Services (CMS). Apply for and renew annually all provider licenses; Professional, Controlled Substance.    
• Complete revalidation requests issued by government payers.    
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete re-credentialing applications for commercial payers. Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
• Work closely with the CFO and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Work with the HR Recruiter to ensure new hires start the credentialing process at the earliest entry point.
• Maintain accurate provider profiles in CCS databases.
• Work with the management team and programs to ensure credentialing operations are effective and meet standards developed by the respective licensing authorities and state agencies.
• Provide technical assistance to ensure that relevant data are collected, and reports are generated to inform staff of progress in meeting standards and outcomes as identified.
• Remain current on Health Insurance Claim (HCFA) requirements, Medicare, Medicaid and Oregon Health Care Plan requirements and other third-party rules and regulation for mental health, addictions, and various Public Health programs.
• Relieve Office Support Personnel daily for breaks and lunches and provide backup coverage in their absence. Perform duties of Office Support Personnel that pertain to processing of clients or handling the public when acting in backup capacity.
• Perform other tasks or projects as assigned.

QUALIFICATIONS

Education and/or Experience

High school diploma or equivalent G.E.D. certificate.  

Certifications

Ability to become a site specialist for Oregon Community Health Information Network (OCHIN) within 6 months of employment.

Other Skills and Abilities

Considerable knowledge of office principles and practices. General knowledge and experience of basic accounting procedures, word processing and data entry. Work must be performed with a high degree of accuracy.  

Knowledge of computer databases is essential. Requires competency in Electronic Medical Records used for behavioral health, primary care, and public health

Must be a self-starter and have the ability to work effectively with other employees and the general public.

In depth knowledge of payers (federal, state and private) fiscal requirements and guidelines, or the ability to acquire such knowledge.  

Good organizational and time management skills are essential.  

Must be able to work with minimal supervision.  

Must have in depth knowledge of standard office equipment to include computer, phone system, copier and fax machines.  

The position requires the handling of highly confidential information. Must adhere to rules and laws pertaining to client confidentiality.  

Must be able to communicate effectively in both written and oral formats. Must have the ability to present and exchange information internally across teams and co-workers, and externally with customers and the public. Information communicated ranges from routine/basic to complex and confidential information. 

CRIMINAL BACKGROUND CHECKS

Must pass all criminal history check requirements as required by ORS 181.536-181.537 and in accordance with OAR 410-007-0200 through 410-007-0380.

In addition to a pre-employment background check, each employee, volunteer and contractor shall be checked on a monthly basis against the OIG and GSA exclusion lists, as well as other federal and state agency lists. If it is discovered that an employee, volunteer or contractor is excluded or sanctioned it will be the cause for immediate termination of employment, volunteering, or the termination of the contract.

PERSONAL AUTO INSURANCE

Must hold a valid driver’s license as well as personal auto insurance for privately owned Vehicles utilized for CCS business such as client service purposes, travel between 

business offices and the community, to attend required meetings and trainings. 

Must show proof of $300,000 or more liability coverage for bodily injury and proof of $100,000 or more liability coverage for property damage, and maintain said level of coverage for the duration of employment at CCS. 

The employee’s insurance is primary with CCS insurance being secondary. CCS reserves the right to deny any employee the use of a vehicle owned by CCS. 

PHYSICAL DEMANDS

While performing the essential duties of this job, the employee is regularly required to use office automation including computer and phone systems that require fine manipulation, grasping, typing and reaching.

The employee is also regularly required to sit; talk and hear; use hands and fingers and handle or feel. The employee is occasionally required to stand; walk; reach with hands and arms; stoop; kneel and/or squat when adjusting equipment or retrieving supplies. 

The employee may occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, distance vision and the ability to adjust focus.

WORK ENVIRONMENT

Work is performed in an office environment and the noise level is usually moderate, but occasionally may be exposed to loud noise such as raised voice levels and alarms. Occasional out of area travel and overnight stays will be required for attendance at meetings or trainings. 

This position may be exposed to the everyday risks or discomforts which require normal safety precautions typical of such places as an office (i.e. moving mechanical parts, airborne particles, electrical shock, etc.).

Community Counseling Solutions

IS AN EQUAL OPPORTUNITY EMPLOYER

MEMBER OF NATIONAL HEALTH SERVICES CORPORATION