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Team Lead - Credentialing in Latham, NY at Beacon Health Options

Date Posted: 3/14/2019

Job Snapshot

Job Description


The Credentialing Team Lead is responsible for supporting Credentialing team members and overseeing the day to day workflow of the Credentialing Department. The Credentialing Team Lead is responsible for credentialing and re-credentialing of behavioral health providers and facility organizations (hospitals, mental health centers, etc).  The Credentialing Team Lead is responsible for collecting credentialing documentation and accurately building provider credentialing files according to contractual and NCQA standards using Beacon’s Network Connect Credentialing System. The Credentialing Team Lead position requires independent business decisions to be made to complete credentialing files prior to submission to the Credentialing Committee. The Credentialing Team Lead is responsible for functions including but not limited to initial review of practitioner and facility applications, management of re-credentialing files, and obtaining primary source verification for completion of credentialing and re-credentialing files. The Credentialing Team Lead is a first escalation resource for Credentialing staff, providing mentoring, assistance, answering questions about policies and procedures, directing to resources and training on departmental processes. The Credentialing Team Lead, in conjunction with department management, identifies training needs for staff members, assists the department in reaching contractual, production and quality goals, and supports the organizational goals of process cycle times, customer service, efficient processes, organizational competency and value-added services to support Beacon’s provider network.

Position Responsibilities:

  • Assists with managing daily workflow of the credentialing team.
  • Leads by example. Guides, supports and mentors junior members of the team.
  • Displays a positive, constructive, and helpful demeanor to assist team members and offer suggestions that improve processes, culture or working environment.
  • Assists management with identifying opportunities for staff improvement, high- performing team members, and training needs of team member.
  • Using production and quality audit results, provide staff feedback and perform individual and group training as indicated.
  • Assign work to assure appropriate workloads and timely completion.
  • Assist management with coordination of client audits.
  • Coordinate delegated credentialing functions.
  • Complete reporting for internal purposes or state/plan requirements.
  • Collaborate with Network Operations, Network Development and other Beacon staff to ensure follow up with providers when applications are incomplete.
  • Monitor re-credentialing timeliness and make management aware in the event that timeliness standards are at risk.
  • Assist in performing and tracking the ongoing sanction monitoring process.
  • Accurately enters information into Beacon’s system of record.
  • Stays current with knowledge of NCQA credentialing and re credentialing standards.
  • Assists with the revisions and/or development of policies and procedures.
  • Prepares files for the Medical Director and Credentialing Committee.
  • Assist Credentialing Manager with coordination of the Credentialing Committee functions.
  • Assist with production when necessary, including, but not limited to performing Primary Source Verification for individual credentialing & confirmation of facility accreditation and licensure.
  • Credential and re-credential behavioral health providers using Beacon’s proprietary system.
  • Supports special projects as needed. 

Position Requirements:

Education: High School Diploma/GED required.

Relevant Work Experience:

  • 2.5 years’ experience in insurance, medical, healthcare or related field required, including one year of credentialing experience.
  • One year of experience as a Beacon Credentialing Specialist I and II combined, meeting the production and quality standards of a Credentialing Specialist II for at least four months.
  • Strong leadership characteristics and ability.
  • Professional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon’s internal systems.
  • Ability to learn quickly.
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Ability to work in a production environment and meet production and quality goals.
  • Computer literacy and experience with Microsoft office programs (Outlook, Word and Excel), Adobe PDF creator and internet searches. Experience working with fax machines, copiers and other office machines.

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled


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