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CREDENTIALING SPECIALIST I in Latham, NY at Beacon Health Options

Date Posted: 3/7/2019

Job Snapshot

Job Description

The Credentialing Specialist I is responsible for credentialing and re-credentialing of behavioral health providers and facility organizations (hospitals, mental health centers, etc).  The Credentialing Specialist I is responsible for collecting credentialing documentation and accurately building provider credentialing files according to contractual and NCQA standards using Beacon’s NetworkConnect Credentialing System. The Credentialing Specialist I position requires independent business decisions to be made to complete credentialing files prior to submission to the Credentialing Committee. The Credentialing Specialist I 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 Specialist I also acts as a resource to department team members and external departments in the day-to-day functions of the Credentialing Department.

Position Responsibilities:

  • Credential and re-credential behavioral health providers and facility organizations (hospitals, mental health centers, etc.) using Beacon’s NetworkConnect credentialing system.
  • Perform verbal, written and on-line primary source verification for individual and facility organizations including but not limited to, state licensure, prescribing certificates/registrations, education, training and certification verification, accreditation status and exclusion data-base checks.
  • Accurately and timely perform data entry of all primary source verifications and select provider demographic and practice location information into Beacon’s NetworkConnect credentialing system.
  • Stay current with knowledge of NCQA credentialing standards.
  • Credential and prepare credentialing and re-credentialing files for weekly Medical Director submission and bi-weekly National Credentialing Committee submission.
  • Monitor work queue to ensure applications are processed within expected turnaround times.
  • Meet or exceed production and quality standards.
  • Display a positive, constructive, and helpful demeanor.
  • Other duties as assigned.

Position Requirements:

  • 2 years’ experience in insurance, medical, healthcare or related field required.
  • 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), and internet searches.

 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