Managed Care Credentialing Representative II

7 days ago

St Louis, United States Burrell Behavioral Health Full time

Job Description:

Under limited supervision of the Managed Care Credentialing Lead, the Managed Care Credentialing Representative II is responsible for meeting with providers to complete all onboarding credentialing application documents and tasks as well as working the application file for committee review in accordance with regulatory standards. The incumbent guides providers through the application and onboarding process, manages application files ensuring all regulatory items are present, and when applicable, recredentials providers in a timely manner.

Essential Job Functions:

+ Meet with all onboarding providers for application and enrollment navigation and assisting the providers with any questions or concerns.

+ Compiles and maintains current and accurate data for all providers within the credentialing database and credentialing file.

+ Completes provider credentialing and re-credentialing applications; monitors application and follows-up in a timely manner.

+ Responsible for the investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice.

+ Notifies supervisors and management of adverse or questionable responses from the verification process.

+ Assist providers whom are needing a change in privileges or license type.

+ Maintain department standards while meeting all required regulations.

+ Other duties as assigned

Knowledge, Skills, and Abilities:

+ Excellent customer service, time management and communication skills (oral and written).

+ Excellent organization skills and attention to detail.

+ Analytical skills and the ability to research industry topics and policies and translate the information into actionable items.

+ Must be able to multitask on various projects while meeting different deadlines

Experience and Education Qualifications:

+ High school diploma, GED or equivalent required.

+ Healthcare Credentialing experience required.

+ Experience in healthcare administration utilizing advanced Microsoft Office and excel preferred.

Supervisory Requirements:

+ None

Employment Requirements:

+ Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.

+ Completion of New Hire Orientation at the beginning of employment.

+ All training requirements including Relias at the beginning of employment and annually thereafter.

+ Current drivers license, acceptable driving record and current auto insurance.

Physical Requirements:

+ The physical requirements and working conditions described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

+ While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands and arms; and talk or hear. Prolonged periods of sitting at a desk.

+ The noise level in the work environment is usually moderate. The employee must be able to perform duties, both in office or while working remote and under all weather conditions.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Brightli is a Smoke and Tobacco Free Workplace.

About Brightli

Brightli is on a mission: A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance use care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. We are doing this by forming a new behavioral health organization under new model. Under one parent company, multiple organizations are able to collaborate, share resources and system supports, increase recruiting and retention efforts, increase access to specialized care, and meet the growing demand for behavioral and addiction recovery care.

Brightlis top-line subsidiaries include Burrell Behavioral Health (Burrell), Preferred Family Healthcare (PFH), Southeast Missouri Behavioral Health (SEMO), Firefly, Adult and Child Health, and Places for People. While these organizations operate independently and are governed by separate board of directors, their operations and services benefit from this model. Alone, organizations may be able to navigate the current tumultuous healthcare environment, but we believe that together we can do so much more than survive. Our communities need us now more than ever, and by working together we are ready to answer their call for years to come.

Brightli Snapshot

+ 200 locations

+ 4 states

+ 19 subsidiaries and/or affiliates

+ 5k+ employees

  • Managed Care Credentialing Specialist

    6 days ago

    St Louis, Missouri, United States Burrell Behavioral Health Full time

    Job SummaryBurrell Behavioral Health is seeking a highly skilled Managed Care Credentialing Representative II to join our team. As a key member of our credentialing team, you will be responsible for ensuring the smooth onboarding process of healthcare providers, ensuring compliance with regulatory standards, and maintaining accurate and up-to-date provider...

  • Healthcare Credentialing Coordinator

    6 days ago

    St Louis, Missouri, United States Burrell Behavioral Health Full time

    Job SummaryBurrell Behavioral Health is seeking a highly skilled Managed Care Credentialing Representative II to join our team. As a key member of our credentialing team, you will be responsible for ensuring the smooth onboarding process of healthcare providers, ensuring compliance with regulatory standards, and maintaining accurate and up-to-date provider...

  • Clinical Service Representative II

    4 days ago

    St Louis, Missouri, United States Washington University in St. Louis Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Clinical Service Representative II to join our team at Washington University in St. Louis. This role will play a critical part in supporting the smooth operation of our physical therapy practice, ensuring seamless patient flow and excellent customer service.Key ResponsibilitiesGreeting and...

  • Care Management Support Coordinator II

    6 days ago

    St Louis, United States BCforward Full time

    Care Management Support Coordinator II BC Forward is looking for Care Management Support Coordinator II (REMOTE) Position Title: Care Management Support Coordinator II (REMOTE) Location: ?REMOTE - EST/CST Anticipated Start Date: 9/16 Expected Duration: 3 months Job Type: Contract to Hire Shift: 8a-5p EST Pay Rate: $20.00/hr on W2 Need: Experience with...

  • Care Management Support Coordinator II

    2 weeks ago

    St Louis, United States BCforward Full time

    Care Management Support Coordinator IIBC Forward is looking for Care Management Support Coordinator II (REMOTE) Position Title: Care Management Support Coordinator II (REMOTE) Location: ?REMOTE - EST/CSTAnticipated Start Date: 9/16Expected Duration: 3 monthsJob Type: Contract to HireShift: 8a-5p ESTPay Rate: $20.00/hr on W2Need: Experience with high Volume...

  • Culinary Services Representative II

    2 weeks ago

    St Petersburg, United States BayCare Health System Full time

    About BayCare Health System:BayCare Health System stands as a prominent employer in the Tampa Bay region, encompassing a network of 16 community hospitals, a long-term acute care facility, home health services, outpatient centers, and a vast array of physicians. Our dedicated team of over 30,000 professionals is committed to fostering a culture rooted in...

  • Provider Onboarding Specialist

    6 days ago

    St Louis, Missouri, United States Burrell Behavioral Health Full time

    Job SummaryBurrell Behavioral Health is seeking a highly skilled Managed Care Credentialing Representative II to join our team. As a key member of our credentialing team, you will be responsible for ensuring the smooth onboarding process of healthcare providers, ensuring compliance with regulatory standards, and maintaining accurate and up-to-date provider...

  • RN Care Manager II

    2 months ago

    St Louis, United States Mercy Full time

    We're a Little Different Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals - careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine...

  • Securities Operations Representative

    1 week ago

    St Louis, United States Calculated Hire Full time

    Securities Operations Representative II Onsite – St. Louis, MO 3-month Contract (W2), Weekly Pay (40 hours/week) Pay Range: $18-20/hour Desired Start Date: 10/1/2024 Calculated Hire is in search of a Securities Operations Representative II for our Fortune 100 Financial Services company's Asset Movement Group. You will be responsible for the following...

  • Patient Billing/Services Representative II

    2 days ago

    St Louis, Missouri, United States Washington University Full time

    Job SummaryWashington University is seeking a highly skilled Patient Billing/Services Representative II to join our team. As a key member of our healthcare team, you will be responsible for obtaining insurance information and referral forms, counseling patients on financial assistance, and registering new patients.Key ResponsibilitiesObtain insurance...

  • Culinary Services Representative II

    2 weeks ago

    St Petersburg, United States BayCare Health System Full time

    About BayCare Health System:BayCare Health System stands as a leading employer in the Tampa Bay region, comprising a network of 16 community hospitals, a long-term acute care facility, home health services, outpatient centers, and a vast array of physicians. Our workforce of over 30,000 dedicated professionals fosters a progressive culture grounded in trust,...

  • Customer Service Representative II

    6 days ago

    Bay St Louis, United States Hollywood Casino Gulf Coast Full time

    About the RoleWe are seeking a highly skilled and customer-focused Customer Service Representative II to join our team at Hollywood Casino Gulf Coast. As a key member of our Player Services team, you will be responsible for providing exceptional service to our guests, ensuring their experience is memorable and enjoyable.Key ResponsibilitiesGuest Service:...

  • Customer Service Rep II

    2 months ago

    St Louis, United States BJC HealthCare Full time

    The Customer Service Representative II serves as an advocate for patients and their families. This position provides communication support, guidance, interpretation and education on complex and/or escalated billing, claim status and customer-related Customer Service, Service, Retail, Healthcare, Patient, Customer

  • Securities Operations Representative

    1 week ago

    st. louis, United States Calculated Hire Full time

    Securities Operations Representative IIOnsite – St. Louis, MO3-month Contract (W2), Weekly Pay (40 hours/week)Pay Range: $18-20/hourDesired Start Date: 10/1/2024Calculated Hire is in search of a Securities Operations Representative II for our Fortune 100 Financial Services company's Asset Movement Group. You will be responsible for the following...

  • Securities Operations Representative

    2 weeks ago

    St. Louis, United States Calculated Hire Full time

    Securities Operations Representative IIOnsite – St. Louis, MO3-month Contract (W2), Weekly Pay (40 hours/week)Pay Range: $18-20/hourDesired Start Date: 10/1/2024Calculated Hire is in search of a Securities Operations Representative II for our Fortune 100 Financial Services company's Asset Movement Group. You will be responsible for the following...

  • Securities Operations Representative

    1 week ago

    st. louis, United States Calculated Hire Full time

    Securities Operations Representative IIOnsite – St. Louis, MO3-month Contract (W2), Weekly Pay (40 hours/week)Pay Range: $18-20/hourDesired Start Date: 10/1/2024Calculated Hire is in search of a Securities Operations Representative II for our Fortune 100 Financial Services company's Asset Movement Group. You will be responsible for the following...

  • Securities Operations Representative

    2 weeks ago

    St Louis, United States Calculated Hire Full time

    Securities Operations Representative IIOnsite – St. Louis, MO3-month Contract (W2), Weekly Pay (40 hours/week)Pay Range: $18-20/hourDesired Start Date: 10/1/2024Calculated Hire is in search of a Securities Operations Representative II for our Fortune 100 Financial Services company's Asset Movement Group. You will be responsible for the following...

  • Clinical Service Representative II

    4 days ago

    St Louis, Missouri, United States Washington University in St. Louis Full time

    Job SummaryWashington University in St. Louis seeks a highly motivated and detail-oriented Clinical Service Representative II to provide exceptional patient support in a fast-paced medical office setting. As a key member of our team, you will be responsible for delivering outstanding customer service, ensuring seamless patient experiences, and contributing...

  • Dialysis Technician II

    6 days ago

    St Louis, Missouri, United States Washington University in St. Louis Full time

    Job SummaryWashington University in St. Louis is seeking a highly skilled Dialysis Technician II to join our team. As a Dialysis Technician II, you will play a critical role in providing exceptional patient care and support in our outpatient dialysis setting.Key ResponsibilitiesEquipment Management: Arrange and maintain equipment and supplies for dialysis...

  • Patient Service Representative

    4 days ago

    St Louis, Missouri, United States ZOLL LifeVest Full time

    Job Opportunity: Patient Service RepresentativeAbout the Role:ZOLL LifeVest, a leading manufacturer of lifesaving medical technology, is seeking a Patient Service Representative to join our team as an independent contractor. As a Patient Service Representative, you will play a critical role in training patients on the use and care of the LifeVest, a wearable...