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Credentialing Specialist I in Latham, NY at Beacon Health Options

Date Posted: 4/7/2019

Job Snapshot

Job Description

The Credentialing Specialist I is responsible for credentialing and recredentialing 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 recredentialing files, and obtaining primary source verification for completion of credentialing and recredentialing 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.

 Responsibilities:

  • Credential and recredential 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 database 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 recredentialing 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.

Requirements: 

  • 2 years of experience in the Medical, Healthcare or Insurance industry
  • Credentialing experience is Highly desirable
  • Professional demeanor, strong written and oral communication skills
  • Quick study, able to pick up new skills quickly
  • Detail-oriented, highly organized with excellent problem-solving skills
  • Ability to multi-task, manage varying job pressures and meet deadlines
  • Independent, able to work 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
  • Experience working with fax machines, copiers and other office machines
  • High School Diploma or High School Equivalent 

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.

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