Provider Credentialing & Compliance Specialist

Behavioral Health Network, Inc.; Springfield (MA); Presencial; USD 33.000 - 37.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Generous PTO

403(b)

Educational assistance

Medical insurance

Dental insurance

Vision insurance

Employee assistance program

Descripción de la vacante

Behavioral Health Network, Inc. seeks a credentialing professional to manage initial and recredentialing applications for clinicians, verify credentials, and monitor licensure and sanctions.

You will coordinate with the credentialing committee and ensure accuracy of staff credentials and insurance eligibility. Role requires familiarity with PECOS, NPI, CAQH, and insurance contracts; strong attention to detail and ability to escalate issues to the Clinical Director.

Formación

• High school diploma or GED required.
• Knowledge of insurance, clinical license levels and educational degrees, CPT coding, and guarantor credentialing standard required.
• Familiarity with PECOS, NPI, CAQH, OIG exclusion list and Med Advantage required.
• Insurance background with coding and billing required.

Responsabilidades

• Processes individual provider initial credentialing applications, and biennial recredentialing applications.
• Assists in onboarding clinical staff by verifying credentials, identity, degrees, certification, work history, etc.
• Monitors electronic credentialing workflow. Evaluates the quality of information provided by the CVO and escalates exceptions to the Clinical Director for review.
• Ensures each individual credentialing application is processed by the credentialing committee for all initial and recredentialed clinical staff.
• Monitors State Professional Licensure, Board Certification, DEA, CDS and other credentials as required. Reviews for pending expiration dates and follows up with staff to ensure their compliance.
• Reviews CredentialStream alerts for State exclusions and professional licensing sanctions, OIG exclusions, SAM exclusions, Federal Sanctions, and notifies the Clinical Director of all identified concerns.
• Maintains database of credentialed staff in CredentialStream, which includes staff credentials and insurance eligibility.
• Prepares payer rosters and delegates credentialing oversight reports using the cadence defined by each insurance company.
• Enrolls and empanels eligible clinical staff as determined by insurance contracts.

Conocimientos

Insurance knowledge

Clinical license knowledge

CPT coding

PECOS familiarity

Educación

High school diploma or GED

Herramientas

CredentialStream

State licensure checks

Descripción del empleo

Behavioral Health Network, Inc. seeks a credentialing professional to manage initial and recredentialing applications for clinicians, verify credentials, and monitor licensure and sanctions.

You will coordinate with the credentialing committee and ensure accuracy of staff credentials and insurance eligibility. Role requires familiarity with PECOS, NPI, CAQH, and insurance contracts; strong attention to detail and ability to escalate issues to the Clinical Director.