Credentialing Specialist

Beacon Behavioral Partners; Plano (TX); Presencial; USD 52.000 - 65.000; Jornada completa

Descripción de la vacante

Beacon Behavioral Partners in Plano, TX is seeking a Credentialing Specialist to join our Revenue Cycle Team. This full-time onsite role at our corporate office focuses on provider enrollment, credentialing, and maintaining data accuracy across credentialing databases.

The candidate will handle primary source verification, initial and re-credentialing, and communication with payers to secure in-network status. Strong organizational skills and Microsoft Office proficiency are essential.

Formación

• Bachelor’s degree in healthcare administration, business administration, or related field.
• Minimum 3 years of provider enrollment and credentialing experience.
• Extensive knowledge of provider enrollment regulations 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; CPCS certification preferred.

Responsabilidades

• Compile and maintain current and accurate data for all providers.
• Data entry and maintenance in credentialing databases and systems (Credential My Doc, CAQH, PECOS, NPPES, and SharePoint).
• Primary source verification of state licenses, DEA, and board certification.
• Complete provider initial and re-credentialing applications.
• Audit applications for accuracy and completeness.
• Monitor revalidation requests issued by payers.
• Submit credentialing applications and supporting documentation to payers.
• Track application progress and follow up with payers until in-network status is confirmed.
• Maintain copies of licenses, DEA certificates, malpractice coverage, and credentialing documents; track expirations.
• Track CME and send quarterly updates to providers.
• Assist in training credentialing staff and streamline processes.
• Escalate issues to Credentialing Supervisor and liaise with RCM leadership.

Conocimientos

Data entry

Primary source verification

Credentialing processes

Payer enrollment

Microsoft Office

CPCS certification

Educación

Bachelor's degree in healthcare administration

Bachelor's degree in business administration

Herramientas

Credential My Doc

CAQH

PECOS

NPPES

SharePoint

Microsoft Office Suite

Descripción del empleo

Beacon Behavioral Partnersis looking for aCredentialing Specialistto join our team. This full-time position has the opportunity to work with our Revenue Cycle Team and will work onsite at our corporate office located in Plano, TX. We are a growing network of physician-driven psychiatric practices withover 25 years of management experiencewithin the behavioral health industry. Committed to reducing the barriers and burdens that come with owning private practice, Beacon fullymanages administrative responsibilitieswhile allowing practices tomaintain clinical autonomy. This approach allows physicians to focus on what they do best –taking care of patients.

Beacon Behavioral Partnersnow guides practices across Louisiana, Arkansas, Mississippi, Florida, Texas and multiple other states across the US. Beacon Behavioral Partners leverage access to an expansive network ofover 1000 staff members, includingpsychiatrists, psychologists, nurse practitioners, mental health therapists and recreational therapistsat 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.

RESPONSIBILITIES AND DUTIES

• 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 escalation provide enrollment issues to RCM leadership.

Qualifications:

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)

Certified Provider Credentialing Specialist (CPCS) certification preferred.

Only those selected for interviews will be contacted. Pre-employment screenings and verification of credentials (if applicable) is required prior to start date. Beacon uses E-verify to confirm the employment eligibility of all newly hired employees. To learn more about E-verify, including your rights and responsibilities, please visit www.dhs.gov/E-verify (http://www.dhs.gov/E-verify).

Beacon is an Equal Opportunity Employer.