Hybrid Credentialing & Compliance Specialist

Acadia Healthcare; Franklin (TN); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Competitive Base Salary

Medical, Dental, Vision Insurance

401(k) Plan with Company Match

PTO and holidays

Life and AD&D Insurance

Employee Assistance Program

Growth opportunities within nationwide

Job summary

Acadia Healthcare is seeking a Credentialing Specialist to support our facilities in the credentialing portion of managed care and contracting processes. You will prepare documentation for Medicare, Medicaid, and commercial payer submissions and monitor PECOS entries to ensure timely, compliant processing.

Ideal candidates have 1–3 years of healthcare experience, strong attention to detail, and excellent written and interpersonal skills to interact with internal and external stakeholders while

Qualifications

• BA/BS degree preferred but not required.
• 1-3 years healthcare experience required.
• Basic to working knowledge of managed care concepts.
• Documentation, proficiency, attention to detail, and organization skills are essential.
• Excellent communication skills, especially written, and the ability to concisely summarize.
• Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level.
• Self-motivated with strong organizational skills and superior attention to detail.
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes.
• Capable of working within established policies, procedures and practices prescribed by the organization.

Responsibilities

• Assist in the preparation of applications for physician and facility participation in payer programs, including Medicare 855A, 855B, 855I and 855R and similar applications for Medicaid programs and managed care plans.
• Track and monitor facility entries in Medicare’s PECOS database.
• Assist facility credentialing leads in the preparation of Disclosure of Information documents requiring corporate validation and signature.
• Prepare and submit initial state Medicaid enrollments and re-validations.
• Prepare and administer facility information to the NPPES website. This will include initial NPI for new facilities, edits to existing NPIs, and Group NPI’s for physician billing.
• Work closely with Corporate Director of Managed Care to ensure efficiency of processes and create new work flow tools as needed.

Skills

Healthcare experience

Managed care concepts

Attention to detail

Organization skills

Written communication

Interpersonal skills

Multitasking

Education

BA/BS degree

Job description

Acadia Healthcare is seeking a Credentialing Specialist to support our facilities in the credentialing portion of managed care and contracting processes. You will prepare documentation for Medicare, Medicaid, and commercial payer submissions and monitor PECOS entries to ensure timely, compliant processing.

Ideal candidates have 1–3 years of healthcare experience, strong attention to detail, and excellent written and interpersonal skills to interact with internal and external stakeholders while