Address
Form of workEducation and Work Experience:
• Must have at least 1 year experience in medical or behavioral health credentialing. ABA experience is preferred, but not required.
• Familiarity with NPPES, PECOS and CAQH
• Basic knowledge and understanding of the contracting and credentialing process.
• Bachelor's degree preferred.
• Experience with CentralReach helpful, but not required.
• Prior experience contracting and/or credentialing for Medicaid and MCOs desired, but not required.
Required Skills and Attributes:
• Effective written and verbal communication skills. Must be able to communicate effectively with providers and insurance representatives to achieve desired outcomes.
• A keen attention to detail and ability to accurately fill out paperwork with minimal mistakes. Strong visual discrimination ability to recognize misspellings and number transpositions.
• Must be sensitive regarding confidential information (employee social security numbers, background checks, etc).
• Comfortable with technology (practice management system, MS Word, MS Excel). Expertise in these items isn't necessary, but candidate should be comfortable exploring within a software program and learning how to do new tasks.
• Must be able to navigate payor websites to find procedural information and appropriate points of contact.
• Excellent problem-solving abilities - no one knows all the answers, but candidate should be comfortable using available resources and taking initiative to find answers to questions they do not know and to find solutions to problems.
• Must be a self-starter with a positive attitude and demonstrate a willingness to learn
Duties and Responsibilities:
• Assist new BCBAs with obtaining an NPI and filling out a CAQH profile when needed.
• Regularly review and attest all our providers' CAQH profiles, ensuring that all information is up-to-date and the attestation is not expired.
• Update provider CAQH profiles as needed (add or remove locations, update liability insurance, etc).
• Maintain accurate and up-to-date provider information records (NPI, SSN, practice location, license # and expiration date, etc).
• Collect, store and review provider documentation needed for credentialing purposes.
• Accurately complete online and/or paper credentialing applications.
• Acquire and maintain working knowledge of all payor policies, procedures and credentialing requirements. Notify leadership when there is a major change that will affect clinical or reimbursement operations.
• Follow-up on submitted applications in a regular cadence, according to payor processing timelines
• Work directly with payors, providers and/or leadership to resolve any application deficiencies or disqualifications
• Maintain accurate records of provider network statuses, recredentialing and revalidation dates. Submit recredentialing and revalidation applications before due date.
• For payors that have rostered group contracts, add new providers to our group as needed.
