Practitioner Enrollment & Credentialing Specialist

Job Title: Practitioner Enrollment & Credentialing Specialist

Site Location: Remote

Classification: Full-Time, Non-Exempt

Reports To: Director of Provider Relations

Salary Grade: TBD

Summary/Objective: The Practitioner Enrollment & Credentialing Specialist performs a variety of complex credentialing functions, including maintaining Smartsheet records, submitting applications to third-party liability organizations and Medicaid, and acts as a resource to agency staff; attending client calls when necessary and works closely with the management team.

Essential Functions:

• Completes enrollments and renewals of individual service providers licenses, certifications and other credentialing documentation as required for Commercial, Medicare, and Medicaid payers.
• Oversees accuracy of CAQH, PECOS, NPPES and PNM credentialing databases in accordance with CMS requirement for eligible service providers.
• Manages credentialing files using company systems and applications such as SharePoint, CareLogic and Smartsheets to ensure up-to-date documentation is available during the enrollment and renewal process for assigned providers.
• Maintains internal credentialing reports, provider rosters and agency spreadsheets to ensure credentialing information and provider logins are accurate for assigned providers.
• Maintains performance standards through monthly QA audits and quarterly skills assessments.
• Addresses inquiries related to credentialing inconsistencies, provider enrollments and participates in Client Touch Base calls as assigned.
• Analyzes data to identify trends, address issues, and recommend improvements to enhance the credentialing process.
• Coordinates with other departments, consistently seeks improvement of all functions to ensure department activities are conducted efficiently and ethically that align with company goals.
• Demonstrates working knowledge of Behavioral and Mental Health billing/coding for Medicare, Medicaid, National and Local Commercial insurance provider types.
• Ensures management is notified of changes to guidelines published for review through provider portals, newsletters and correspondence notifications supplied by all third-party payors.
• Maintains strict confidentiality and adheres to all guidelines and regulations regarding patients’ medical records and billing records, including BHBS Operations Policies and Procedures and HIPAA.
• Participates in relevant continuing education, in-service training to improve professional competency and ensure that all daily activities are completed efficiently, and of company goals are achieved.

Competencies: The employer operates a policy of ‘Job Flexibility’ and may require you to perform additional or other duties, whether skilled or unskilled, and not within the scope of your normal duties. The employer reserves the right to amend your position description at any time.

Supervision: Direct reports are not assigned to this Position.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or listen. The employee may be required to stand, walk; use hands to type, handle or feel; and reach with hands and arms. This is largely a sedentary role; however, some physical movement is required. This would require the ability to lift and bend or stoop as necessary. This position requires the ability to occasionally lift office equipment and supplies, up to 20 pounds.

Work Environment: This job operates remotely in a private professional environment. Employees shall devote their full business time to the business affairs of the company and shall perform their duties faithfully and efficiently subject to the direction of the executive staff of the company. Complying with the directives provided to in observance the company policies, procedures and rules as introduced and/or amended at the employer’s discretion.

This role routinely uses standard office equipment and requires that all employees “BYOD” - Bring Your Own Device. Employees are required to utilize their own equipment and equipment related supplies (see list of hardware requirements attached).

Position Type/Expected Hours of Work: Some flexibility in hours is allowed, but the employee must be available during the "core" work hours of Monday through Friday 8:30 a.m. to 5:00 p.m. and must maintain a regular 40-hour work week schedule to be eligible for full-time status.

Travel: While this position is classified as Remote, travel may be expected to attend Conferences, Training Seminars and other designated locations. The employer reserves the right to relocate you, with reasonable notice, to such designated locations as deemed necessary from time to time.

Required Education and Experience: 2 years' experience in Behavioral Health Billing and Provider Credentialing required. Knowledge/proficiency in all Microsoft Office applications and any Electronic Health Records database is required. A combination of training, education and experience that is equivalent to the requirements listed above is acceptable in providing the recommended knowledge, skills, and abilities as required.

Additional Eligibility Qualifications: Ten Key calculators, keyboards and other hardware experience required.

AAP/EEO Statement: BHBS provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Work from Home and Equipment Requirements: As a condition of employment with BHBS, employees are expected to routinely use standard office equipment and equipment related supplies to fulfil their duties daily.

BHBS requires that all office equipment and equipment related supplies are to be furnished by the employee. Employees are responsible for providing the necessary computer equipment, software and network access that is essential to complete their job functions, as well as appropriate office supplies (i.e., pens, paper, ink) as requested and deemed necessary. Employees are responsible for all costs and maintenance of home networking security and equipment (e.g., wireless access points, broadband router).

Standard Office Equipment: The following types of approved equipment include (not limited to):

• Computer Laptop/Desktop (see Hardware Requirements)
• Monitors (2 minimum for this position)
• Headset (preferred but not required)
• Keyboard and Mouse (device pad optional)
• Webcam and Microphone
• Printer and Ink Cartridges (optional)

Hardware Requirements: To ensure the employee’s self-furnished Computer Laptop/Desktop hardware meet operating and functional requirements mentioned above, the following system specifications have been recommended to assist employees meeting policy requirements.

• CPU Speed - Dual -Core 2.8 GHz or better or intel I class or AMD Phenom X2 class or better.
• Hard Drive – 20 GB or more of available space. 60 GB or more of total space.
• Memory – 4 GB of RAM minimum. 8 GB of RAM or better is preferable.
• Speed of Internet – Minimum of 10 mbps download / Minimum of 3 mbps upload.
• Maximum Latency Threshold – 120 milleseconds (ms)
• Monitor Recommendations – 1280 x 1024 (SXGA) screen resolution. 1920 x 1080p))
• Operating system – Windows 11 with latest updates.
• Windows 11 encompasses an anti-virus and ransomware product. Any additional anti-virus and/or ransomware is encouraged but not required.
• Microsoft 365 or Office 2021 or higher.
• Separate windows login for work purposes only.

A Windows 11 PC is preferred, however with prior approval use of a MAC with an operating system of macOS Catalina 10.16.7 or latest version, may be approved, if the employee has the knowledge and skill required for appropriate setup to run Windows 11.

It is important that employees understand the “BYOD” (Bring Your Own Device) equipment and equipment related supply requirements and expected conditions of the equipment utilized. In addition, the employee equipment self-furnished is expected to be accessible, operational, and functional upon orientation day.

Job Type: Full-time

Pay: From $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Experience:

• Enrollment, Credentialing and/or Behavioral Health Billing: 2 years (Preferred)

Work Location: Remote