Easterseals MORC is hiring for a Privileging & Credentialing Specialist to help
make a difference and become part of something bigger than yourself! While this
position is mostly remote, it does come to our Clinton Township office and
requires the successful candidate to reside in the state of Michigan.
We are looking for Game Changers!
The types of people who wake up excited to make a difference. The superheroes of
their field who care about the people they serve. If that sounds like you, we
want you on our team.
Benefits of Being a Superhero!
Benefits:
Low-cost Dental/Health/Vision insurance
Dependent care reimbursement, and up to 5 days paid FMLA for maternity,
paternity, foster care and adoption.
Generous 401K retirement plan
Paid Leave Options Available
Up to $125 bonus for taking 5 days off in a row.
10 paid holidays and 3 floating holidays (Over 30 days total of paid time
off)
Wellness Programs
We are a PSLF (Public Service Loan Forgiveness) Employer.
We provide bonuses and extra incentives to reward hard work & dedication.
Mileage reimbursement in accordance with IRS rate.
Free financial planning services through our partnerships with the LoVasco
Consulting Group, and SoFi.
Student loan repayment options
Pet Insurance
Qualifications:
Associates Degree in Business Administration or related field
Five years of experience in a clinic, business, or medical staff office
preferred
Three years of credentialing and provider enrollment experience preferred
Duties and Responsibilities:
1. Processes initial credentialing, privileging, re-credentialing and
re-privileging applications of behavioral health care providers for internal
staff and external independently contracted clinicians.
2. Responsible for coordination and processing of provider enrollment
applications and supporting documentation for third-party payer enrollment and
re-enrollment for insurance credentialing for both internal and external staff.
3. Follows up on the status of applications and tracks progress on all pending
applications.
4. Maintains the provider files and reports, which include provider
demographics, correspondence with insurance plans, status of applications and
pertinent licenses and certifications.
5. Works with providers (internal and external) in person, by phone, or email to
obtain provider privileging and credentialing and insurance enrollment forms and
all supporting documentation.
6. Maintains current and accurate data needed for the credentialing and
re-credentialing process for all providers.
7. Prepares credentials file for completion and presentation to privileging
committee.
8. Utilizes the credentialing database and performs query, report and document
generation; submits and retrieves National Practitioner Data Bank reports in
accordance with FTCA and HRSA requirements.
9. Conducts thorough background investigation, research and primary and
secondary source verification of all components of the application file per FTCA
and HRSA requirements.
10. Identifies issues requiring additional investigation and evaluation;
validate discrepancies and ensure appropriate follow up.
11. Maintains and track copies of current state licenses, certifications,
malpractice coverage and any other required credentialing documents for all
providers.
12. Responds to inquiries from payer organizations regarding credentialing and
privileging issues as they arise.
13. Maintains Credentialing and Privileging data related to Independently
Contracted Providers for submission to privileging committee every two years or
less, as set by the current credentialing/privileging policies.
14. Works with HR specialists, contracting departments, network management and
provider representatives to assist in a timely enrollment process, providing
additional information as required by the individual plan.
15. Follows up with providers to ensure that all necessary information is
received and that the enrollment process is completed timely.
16. Performs follow up with insurance plans to resolve provider enrollment
issues and obtain provider participation status.
17. Performs tracking and follow up to ensure provider enrollments are approved
and linked to the appropriate group entity and location in a timely manner.
18. Maintains documentation and reporting regarding provider enrollments in
process.
19. Maintains up-to-date insurance files with applications, acceptance letters,
provider numbers and completed provider enrollments.
20. Retains detailed and accurate lists of insurance plans in which providers
participate and their effective dates with each plan.
21. Communicates with providers and staff members regarding each provider’s
participation status in insurance plans.
22. Sends updated list of providers and their effective status with insurance
plans regularly to staff as needed.
23. Notifies insurance plan representatives of a provider’s change in status or
when a provider leaves agency.
24. Re-credentials providers as required by individual insurance plans.
25. Scans provider documents and store electronically in provider database.
26. Completes quarterly updated demographics information to Managed Care
Insurances per CMS requirements.
27. Performs other duties as assigned.