Credentialing Specialist

2 weeks ago

Philadelphia, Pennsylvania, United States COMHAR, Inc. Full time
Position Overview

At COMHAR, Inc., our commitment is to deliver health and human services that empower individuals, families, and communities to achieve healthier, self-directed lives. We offer a comprehensive range of recovery-oriented and quality-focused services, including outpatient treatment and residential support, designed to provide high-quality assistance tailored to individual recovery needs.

Role Summary

The Credentialing Specialist plays a crucial role in ensuring that all employees, contractors, and service providers at COMHAR, Inc. comply with necessary credentialing standards in the delivery of services. This position is tasked with the development, implementation, and maintenance of efficient processes for credentialing and re-credentialing, ensuring adherence to all relevant regulatory requirements.

Key Responsibilities
  • Process Development: Establish and maintain effective systems for monitoring and timely completion of credentialing and re-credentialing.
  • Application Review: Lead and coordinate the assessment of healthcare and behavioral health practitioner applications to verify applicant eligibility.
  • Provider Management: Initiate and oversee the credentialing and privileging processes for Licensed Behavioral Health Professionals.
  • Issue Resolution: Identify and address issues that require further investigation and evaluation.
  • Discrepancy Investigation: Validate discrepancies and ensure prompt and appropriate follow-up actions.
  • Audit Preparation: Compile credential files to ensure timely completion and readiness for audits.
  • Inquiry Response: Address inquiries from organizations and collaborate with internal and external stakeholders regarding credentialing and privileging matters.
  • Internal Audits: Conduct audits of internal files and assist with managed care credentialing audits.
  • Verification Assistance: Support the verification of essential pre-employment credentials, including certifications, licenses, education, and clearances.
  • Confidentiality Maintenance: Uphold the highest level of confidentiality regarding all records and information in the execution of job responsibilities.
  • Audit Scheduling: Develop and maintain a schedule for audits across all programs.
  • Data Management: Oversee data entry and documentation within credentialing software.
  • Reporting: Generate monthly reports related to credentialing activities.
  • Travel Requirements: Be prepared to visit various COMHAR locations for credentialing-related tasks as needed.
  • Additional Duties: Perform other responsibilities as assigned.
Qualifications

Essential Qualifications:

  • A minimum of a High School diploma or GED.
  • At least 2 years of relevant credentialing experience in healthcare or human services.
  • Proficiency in Microsoft Office Suite (Word, Excel) and familiarity with HRIS.
  • Comprehensive understanding of full cycle credentialing and re-credentialing processes.
  • Knowledge of Medicaid, Medicare, and Managed Care organizations.
  • Familiarity with clinical operations and procedures.
  • Database management skills, including querying, reporting, and document generation.

COMHAR, Inc. is an equal opportunity employer. We maintain a drug-free workplace and do not discriminate in services or employment based on race, color, religion, ancestry, national origin, sex, sexual orientation, gender identity, age, disability, marital status, veteran status, or any other class of persons protected by law.

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