Managed Care Credentialing Representative I

3 weeks ago

St Louis, United States Burrell Behavioral Health Full time

Job Description:

Essential Job Functions:

+ Solicits primary source verifications only from NCQA and/or Industry approved sources.

+ Document primary source verifications appropriately in accordance with NCQA and/or Industry regulatory standards in a manner that will satisfy auditing requirements from payers, regulatory agencies and/or accrediting bodies.

+ Evaluates all verifications for possible discrepancies with practitioner information and the need for further investigation, escalating to the Credentialing Representative when needed.

+ Makes requests to the National Data Bank and processes sanction checks as required.

+ Monitor and document all Credentialed provider licenses and certifications for expirations and renewals, and appropriately document this in database(s) and provider files.

+ Provide support to Credentialing Representatives when needed.

+ 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.

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

+ Healthcare Revenue Cycle experience 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.

Preferred Family Healthcare 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), and Southeast Missouri Behavioral Health (SEMO). 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

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