Credentialing Specialist I (Remote)

Professional Health Care Network (PHCN) dba tango manages the home health benefit for major insurance plans with a focus on Medicare Advantage and managed Medicaid patients. tango reviews home health care referrals for appropriateness and then coordinates with a network of contracted agencies to provide the care needed for patients. On an ongoing basis, we provide review and oversight of clinical care and determine further authorizations.

tango is looking for a detail-oriented self-starter to work directly with our Senior Manager of Network Operations to provide administrative support in helping manage the credentialing function of the organization. The Credentialing Specialist is responsible for ensuring the tango home health agency network operates in compliance of their agreement with tango, and State and Federal laws. Additionally, the Credentialing Specialist will support audits and projects that affect agency contracting and credentialing.

Responsibilities

Essential functions of the job are listed below. Other responsibilities may also be assigned. Please note that the essential functions may vary depending on department size, organizational structure and/or geographic location. Reasonable accommodations may be made to allow differently-abled individuals to perform the essential functions of the job.

Primary Responsibilities

• Assists in maintaining individual provider files to include up-to-date and compliant documentation as required by federal and state laws, as well as tango’s contract requirements.
• Assists in maintaining accurate provider files on point of contact phone numbers and emails for provider network.
• Supports outreach attempts to providers in obtaining current documentation when documents on file have expired.
• Supports outreach and compliance requirements for re-credentialing every 36 months for providers.
• Inputs information into credentialing software, spreadsheets, and word documents to maintain current information.
• Pulls applicable reports to analyze provider trends and understand current markets.
• Communicate with direct Supervisor and Network team with any issues regarding providers, documents, or other information pertaining to credentialing or re-credentialing.
• Helps to support the direct Supervisor with internal and payer compliance audits
• Communicate process improvement opportunities and work inter-departmentally on process changes and improvement where necessary, alongside direct Supervisor
• Assists with primary source verification checks for Providers on a monthly and quarterly basis
• Comply with HIPAA and tango Compliance policies
• Maintain privacy and confidentiality at all times
• Various other duties, in support of the Network function, on a daily and weekly basis as assigned by direct Supervisor and as needed by the Network team
• Promptly respond time to voicemail, email, and other requests from colleagues

Additional Responsibilities

• The Credentialing Specialist works within the Network department that also manages Configuration and PHCN’s provider Network.
• Additional duties may involve working closely with the Configuration team with data entry, processes, and provider data management.

Minimum Qualifications

The following are the minimum qualifications that an individual needs in order to successfully perform the duties and responsibilities of this position. Please note that the minimum qualifications may vary based upon the department size and/or geographic location.

Knowledge/ Experience

• Equivalent to high school diploma.
• Proficient use of Microsoft Office and Adobe applications (Word, Excel, PowerPoint, etc.).
• Consistent and reliable Wi-Fi.
• Experience in healthcare (home health or credentialing a plus), or similar role, preferred but not required.

Skills/ Abilities Pertinent to This Position

• Strong attention to detail.
• Strong follow-through and follow-up.
• Strong problem-solving and research skills.
• Communication skills
• Organization and planning.
• Experience with working with several different software platforms concurrently.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.