Payer Credentialing Specialist

Job Summary:

The Payer Credentialing Specialist is primarily responsible for project management execution of all Payer credentialing activity, including tracking and submitting credentialing applications and maintaining an organized historical database of these applications for all payers. The Payer Credentialing Specialist will be evaluated on executing the responsibilities effectively and accurately while meeting established deadlines.

The Payer Credentialing Specialist is responsible for submitting initial credentialing applications, reviewing, updating, modifying, and accurately informing the representation of Within Health’s facility configuration to payers, as changes occur. The Payer Credentialing Specialist interprets facility licensure and payer program specifications. Finally, the Payer Credentialing Specialist must understand, appreciate, and protect the confidentiality of the personal information of individuals employed by and serving Within Health.

Responsibilities:

• Effectively manages a portfolio of third-party commercial insurance payers and facility credentialing applications.
• Effectively time manages the receipt and submission of applications to payers based on each payer's cadence.
• Works with organizational leadership to obtain, update, and maintain current data to accurately represent Within Health on credentialing and re-credentialing applications.
• Identifies credentialing issues, coordinates resolution, and takes corrective actions, as needed. Knows when to appropriately escalate issues to the VP of Payer Partnerships and VP of Clinical Operations and Compliance
• Assists with data collection, entry, and analysis related to Value-Based Metrics. The ideal candidate will have experience with large amounts of data entry and will be able to follow up with team members if data is missing or erroneous.

Other Duties and Responsibilities:

• Participates in the development of the Credentialing department’s Policies and Procedures related to facility credentialing.
• Other special projects and other duties as assigned

Required Skills/Abilities:

• Strong verbal and written communication skills.
• Strong reasoning, critical thinking, project management, and analytical skills. Attention to detail.
• Must possess extensive knowledge in the use of Google Products: Gmail, Docs & Sheets, and Zoom. Strength in accessing data via the Internet, ability to effectively use payer websites.
• You have demonstrated knowledge of Behavioral Healthcare credentialing and an understanding of facility credentialing preferred.
• The ability to use effective communication, active listening, emotional intelligence, and expectation management, is helpful.

Education and Experience:

• Associate’s degree with 3 years of experience in a facility credentialing/contracting department required. Bachelor’s Degree with a minimum of 2 years experience in a facility credentialing/contracting department preferred.
• Salesforce experience preferred.