Credentialing Specialist

Beacon Behavioral Partners; United States; On-site; USD 50,000 - 75,000; Full time

Job summary

Beacon Behavioral Partners in Plano, TX is seeking a Credentialing Specialist to join our Revenue Cycle Team. This full-time onsite role focuses on provider enrollment, credentialing databases, and ensuring accurate primary source verification.

Ideal candidates have a bachelor's degree in healthcare administration and at least 3 years of credentialing experience, with strong communication and organizational skills; CPCS is a plus.

Qualifications

• Bachelor's degree in healthcare administration, business administration, or 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.

Responsibilities

• Compiling and maintaining current and accurate data for all providers.
• Data entry and maintaining provider information in online credentialing databases and system.
• Primary source verification of State license, DEA, and Board certification.
• Completing provider initial and re-credentialing applications.
• Audits applications for accuracy and completeness.
• Submitting credentialing applications and supporting documentation to payers.
• Monitoring application progress and following up with payers until in-network status is received.
• Maintaining copies of licenses, DEA certificates, malpractice coverage and expirations.
• Tracking CME and providing quarterly updates to providers.
• Assists in training and monitoring credentialing specialists, assigning work and reviewing for accuracy.
• Assist in streamlining credentialing process, onboarding and offboarding.
• Escalate personnel issues to Credentialing Supervisor.
• Report enrollment issues to RCM leadership.
• Maintain billing insurance grid and provider spreadsheets.

Skills

Communication

Interpersonal skills

Organizational skills

Analytical skills

Attention to detail

Problem solving

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office

Job description

Beacon Behavioral Partners is looking for a Credentialing Specialist to 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 with over 25 years of management experience within the behavioral health industry. Committed to reducing the barriers and burdens that come with owning private practice, Beacon fully manages administrative responsibilities while allowing practices to maintain clinical autonomy. This approach allows physicians to focus on what they do best – taking care of patients.

Beacon Behavioral Partners now guides practices across Louisiana, Arkansas, Mississippi, Florida, Texas and multiple other states across the US. Beacon Behavioral Partners leverage access to an expansive network of over 1000 staff members, including psychiatrists, psychologists, nurse practitioners, mental health therapists and recreational therapists at 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.

Beacon is an Equal Opportunity Employer.