CREDENTIALING SPECIALIST I in Boston, MA at Beacon Health Options

Date Posted: 7/3/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Credentialing Specialist to join our team at our office in Boston, MA.  The Credentialing Specialist will be responsible for maintaining provider credentialing and re-credentialing activities, ensuring Primary Source Verification (PSV) and adhering to credentialing standards for large network of providers. Credentialing Specialist is responsible for all facets of the credentialing process including, but not limited to, knowledge of Massachusetts Behavioral Health Partnership (MBHP)/client specific criteria, accreditation standards (i.e. NCQA, URAC, and JCAHO), credentialing law, legal issues, state statutes, CMS requirements, federal regulatory compliance, external reporting requirements related to quality of care issues/adverse incidents, and in-depth knowledge of the credentialing policies and procedures including support of the credentialing committees and the fair hearing process. Credentialing Specialist must co-coordinate the Local Credentialing Committee, which include taking minutes and presenting agenda items to the Committee members in a concise, organized, and articulate manner. Knowledge of Excel, Outlook, Microsoft Windows, and the Internet for PSV functions is essential.

Position Responsibilities:

  • Manage and maintain the integrity of the provider credentialing database including data entry of credentialing information which requires full comprehension and application of all applicable proprietary software applications (Connect products) in addition to utilization of multiple job aids and/or Access databases.

  • Work independently to research information on provider’s credentials and pay meticulous attention to details for credentialing and provider file tasks.

  • Write and compose provider correspondence, take initiative in identifying systems problems and potential solutions, maintaining accurate record keeping, and other duties as assigned.

  • Co-facilitate the Local Credentialing Committee (LCC), which includes setting the agenda, taking minutes and meeting with the Medical Director prior to the LCC meeting.

  • LCC follow-up, which includes completing any necessary advisory forms for the National Credentialing Committee (NCC), reviewing all previous LCC meeting minutes to ensure any necessary LCC recommendations have been completed (files to contracting, provider correspondence, corrective action data, etc.).

  • Update Policies and Procedures as needed.

  • Ensure standardization of the credentialing and re-credentialing process is congruent with policies and procedures developed by the National Credentialing Committee and all accreditation and/or government standards.

  • Maintain thorough knowledge on current National Committee for Quality Assurance (NCQA) standards for Managed Behavioral Health Organizations. Attend seminars when appropriate.

  • Maintains strict confidentiality of all job related information by ensuring the information is shared with appropriate parties; never divulge information obtained via the investigation process when prohibited by state or Federal law or to individuals not directly involved in the credentialing decision process, including provider’s office staff.  Information may be released to provider according to department’s policies and procedures and must be given in writing.

  • Take on responsibility for challenging or special accounts and processes.  Can participate in implementation planning meetings, assist with workflow development and/or implementation, and other committee or quality related activities.

  • Display reasoning ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.  Ability to deal with complex issues while maintaining a flexible positive, cooperative demeanor.  Flexibility and adaptability to meet periodic changes in departmental needs.  Promotes direct, honest, open and timely communication throughout the company.  Does not filter or misrepresent information.

  • Ability to work in a fast paced environment and prioritize multiple demands. Demonstrate exceptional organizational skills, capable of prioritizing responsibilities, multi task, detail oriented, and ability to work independently with limited supervision.

    Position Requirements:

    Education: High School Diploma or equivalent required. Associate’s or Bachelor’s Degree preferr3ed.   

    Licensure:  CPCS and/or NAMSS certification preferred

    Relevant Work Experience:   Minimum of 3 years’ working experience in the insurance industry (or appropriate education), with one year of healthcare experience preferred. Six months experience in credentialing required.

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

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.