Credentialing & Licensing Specialist

Clinical Health Network For Transformation (CHN); United States; On-site; Full time

Job summary

Clinical Health Network for Transformation (CHN) seeks a Credentialing & Licensing Specialist to manage provider credentialing and payer enrollment tasks. This role involves ensuring compliance and enhancing practices related to health equity. The ideal candidate has a Bachelor’s degree, strong analytical skills, and the ability to work in a fast-paced environment.

Benefits

Health Care Coverage (Medical, Dental, & Vision)

Flexible Spending Accounts and Health Savings Account

Short-Term Disability and Basic Life & AD&D Insurance

Employee Assistance Program

Retirement Plan with employer match

Paid Time Off Program and paid Holidays

Qualifications

• Bachelor’s degree and three years of related experience with credentialing providers.
• Strong analytical and problem-solving abilities with proficiency in Microsoft software.
• Ability to maintain confidentiality and handle sensitive matters.

Responsibilities

• Complete provider credentialing and recredentialing applications with payers.
• Maintain electronic copies of licenses and other required documents.
• Ensure compliance with CHN and relevant state and federal regulations.

Skills

Analytical skills

Problem-solving

Attention to detail

Communication

Interpersonal skills

Education

Bachelor’s degree

Tools

Microsoft software (Excel)

Adobe Acrobat

Job description

Join to apply for the Credentialing & Licensing Specialist role at Clinical Health Network For Transformation (CHN)

Join to apply for the Credentialing & Licensing Specialist role at Clinical Health Network For Transformation (CHN)

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The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.

CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health equity in our organization.

Under the supervision of the Credentialing Manager, the Credentialing & Licensing Specialist is responsible for completing provider credentialing and payer enrollment task for all providers (and provider locations) across the CHN member affiliates. The functions of this position include, but are not limited to, new provider credentialing/ payer enrollment, existing provider re-enrollment and provider information database maintenance (i.e., CAQH, NPPES and PECOS), and ensure prompt renewal of licenses and certifications. This position must have a working knowledge and understanding of data reporting, credentialing and payer enrollment, and basic revenue cycle workflows.

Essential Functions

• Complete, monitor and follow-up as needed, provider credentialing and recredentialing applications with all commercial, Medicaid, Medicare, and Medicaid managed care payers
• Provide all payers with demographic updates when providers are added or terminated
• Create, update, and maintain CAQH Provider data base accounts for clinicians, physician assistants and physicians. Acquire accounts for new providers (APRNs, PAs and physicians) not previously registered with CAQH
• Obtain, update, and maintain the National Plan and Provider Enumeration System (NPPES) / Provider Enrollment, Chain and Ownership System (PECOS) accounts for all APRNs, PAs and physicians
• Maintain electronic copies current state licenses, Board certification, DEA registration and CSR (LA only) certificates, malpractice coverage and any other required credentialing documents for all providers
• Apply for malpractice coverage for new providers (APRNs, PAs and physicians), including off-site emergency coverage for physicians. Annually review the malpractice coverage for all providers with Affiliate Risk and Quality Management or designee
• Develop and maintain instructions for current health plans and federal/state agency requirements for credentialing providers in each health plan or program
• Maintain electronic folder of signed physician contracts including archived contracts
• Manage and maintain confidentiality of provider information, including corporate related information needed for federal/state agencies
• Creates and promotes a culture of continuous improvement
• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
• Provides positive and development feedback and accountability related to practices including, but not limited to, equity
  
  

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at anytime.

Qualifications And Experience (Required)

• Bachelor’s degree and three years of related experience with credentialing providers in a medical practice, with the accompanying knowledge and understanding of the credentialing process with health insurance plans and use of CAQH, or the equivalent combination of education, training, and related experience
• Strong analytical and problem-solving abilities
• Proficiency with Microsoft software (Excel, etc.)
• Must be able to create and edit fillable forms in Adobe Acrobat
• Ability to handle highly confidential and sensitive matters and documents
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Ability to interpret an extensive variety of technical instruction in mathematical or diagram form and deal with several abstract and concrete variables
• Knowledge of business practices and protocols
• Ability to demonstrate initiative and to work with minimal direction
• Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
• Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
• Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
• Demonstrated dedication to Planned Parenthood’s mission, vision, and values
• Strong interpersonal skills and the ability to build relationships with stakeholders
• Excellent time management, and problem-solving skills
  
  

Qualifications And Experience (Preferred)

• Certified Provider Credentialing Specialist Certification (CPCS)
• Experience working with state Medicaid programs is highly desirable
• Strong working knowledge of professional billing software applications
• Two to Five years billing office experience
• One year’s data reporting experience
  
  

Key Requirements

• Commitment to advancing race(+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices
• Understanding of the impact of identity dynamics on organizational culture
• Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards
  
  

$22.37 - $33.56 an hour

CHN believes in fair and equitable pay. Above is the pay range for this role. Please note that actual salaries may vary within the range, based on factors including, but not limited to, education, training, experience, professional achievement, and business need.

CHN provides employees with a competitive benefits package; some highlights include the following:

• Health Care Coverage (Medical, Dental, & Vision); eligibility for full-time, regular employees on date of hire
• Flexible Spending Accounts and Health Savings Account
• Short-Term Disability and Basic Life & AD&D Insurance provided by CHN
• Voluntary elections for Long Term Disability and Additional Life & AD&D Insurance available at cost
• Employee Assistance Program
• Retirement Plan, 3% employer match after one year of service
• Paid Time Off Program includes accrual-based PTO, Health Time Off (HTO), and nine (9) paid Holidays
  
  

Clinical Health Network for Transformation (CHN) is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including members from all racial and ethnic groups and members of the LGBTQIA+ community.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Non-profit Organizations

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