Credentialing Specialist

Who We Are:

Neighborhood Health Center is a non-profit organization local to Portland, OR serving underserved patients in the areas of primary care, internal medicine, dental services and more. Our patient-centered approach to care honors the unique needs and circumstances of each individual patient. NHC sees people, not problems, and recognizes that the time spent as a patient in a doctors office is only one factor in a persons overall health. Our leading edge, integrated clinical teams work in partnership with patients, their families, and the communities we serve to provide whole-person care, prevention, and ongoing support.

NHC is an Equal Opportunity Employer. We celebrate differences in the workplace and do not discriminate in employment opportunities or practices on the basis of race, color, religion, gender (sex), national origin, age, veteran status, sexual orientation, gender identity, disability, genetic information or any other characteristic protected by law.

Why work with us?

• We are a non-profit organization, passionate about providing the underserved population with medical and dental services across the greater Portland area, committed to making a difference daily.
• We offer our employees a competitive compensation and benefits package which includes 20 days of PTO (based on full time employment), 9 paid holidays, health/dental/vision insurance, quarterly wellness reimbursements, generous 401k retirement plan with employer match, employer paid disability insurance, EAP and life insurance.
• Our employees voted NHC a Top Workplace in 2020, 2021,2022, and 2023!

Job Title:  Credentialing Specialist
Department:  Administration
Reports To:  Human Resources Manager
Work Type:  Hybrid
Classification:  Full-Time, Non-Exempt
Language Differential:  Ineligible

SUMMARY

The Credentialing Specialist is primarily responsible for accurately obtaining and maintaining payor credentialing and privileging for Professional and Certified Staff at Neighborhood Health Center.

Essential Job Duties

• Compiles and maintains current and accurate data, licensing, credentials and insurance enrollment for all providers and certified staff.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Tracks credentialing status as well as payer policies regarding credentialing for diverse provider types.
• Assists clinical staff in tracking and completing clinical privileging applications, relays status reports to clinical leadership.
• Assists clinical staff in tracking and renewing basic life support (BLS) certification, assists with coordination of scheduling with in-house BLS program.
• Maintains knowledge of current health plan requirements for credentialing providers including managing delegated health plans.
• Maintains and updates internal credentialing database and payer online portals.
• Ensures that practice addresses and provider rosters are current with health plans and contracts as needed.
• Works with Revenue Cycle Team to manage credentialing holds on claims and assist the billing department with credentialing denials.
• Prepares and maintains reports and other documents as directed to support ongoing stakeholder needs.
• Uses critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
• Actively participates in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Helps develop and maintain internal credentialing policies and processes.
• Responsible for reviewing, processing, and distributing incoming correspondences (i.e., mail, fax and email).
• Provides administrative support to the Human Resources Team as needed.
• Performs other duties as assigned.

QUALIFICATIONS

Don't think that you meet every single requirement? Studies have shown that women, people of color, people with disabilities, and LBGTQ+ people are less likely to apply to jobs unless they think they meet every single qualification. At Neighborhood Health Center, we are dedicated to building a diverse, inclusive, and authentic workplace; so, if you're excited about this role, but your past experience doesn't align perfectly with every preferred qualification in the job description, we encourage you to apply anyway. You may just be the right candidate for this or other roles.

Education and/or Experience

• A high school diploma or equivalent is required
• At least 2 years of medical staff credentialing or enrollment experience is required
• Certified Provider Credentialing Specialist (CPCS) is preferred
• Working knowledge of medical terminology is required
• Demonstrated knowledge of office procedures

Knowledge, Skills & Abilities

• Must have proficient knowledge of Microsoft Outlook, Word, and Excel
• Ability to create and modify Adobe forms as needed
• Knowledge of credentialing software; Verity One App preferred
• Excellent analytical, problem solving, and communication skills
• Position requires a high level of accuracy and attention to detail
• Ability to communicate effectively, both orally and in writing
• Ability to independently solve problems
• Ability to work collaboratively and flexibly in a growing department.
• Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up

WORKING CONDITIONS

• Regularly sit while working on the computer; use hands and fingers to handle, control or feel objects tools or controls; repeat the same movements when entering data; ability to differentiate between colors, shades, and brightness; read from a computer screen for extended periods of time.
• Frequently stand and walk around the office to gather supplies, required to do filing, use office equipment, or collaborate with employees.
• Occasionally stand, stoop and lift or move objects, equipment and supplies weighing approximately 20-25 pounds up to 40-50 pounds.
• The noise level in the work environment is usually moderate.

Neighborhood Health Center Employment Offers are contingent on successful completion of reference checks, background checks, drug screening for illegal substances, Tuberculosis, and any position specific credentialing or licensure requirements.