Managed Care Credentialing Specialist

6 days ago


Towson, Maryland, United States Sheppard Pratt Full time
Job Summary

We are seeking a highly organized and detail-oriented Credentialing Coordinator to join our team at Sheppard Pratt. In this role, you will be responsible for providing administrative support for the credentialing and paneling of PA and Affiliate providers with managed care companies.

Key Responsibilities
  • Process credentialing/recredentialing materials and enrollment applications, track the credentialing status for all providers, and interface with managed care companies.
  • Monitor delays in responses from companies, research problems that impact enrollment, and provide assistance with Sheppard Pratt's credentialing as needed.
  • Establish and maintain a database of credentialing status and enrollment provider/rendering numbers.
  • Develop guidelines, instructions, and articles to assist providers, and provide administrative support for program development.
  • Collect data, prepare reports, and provide administrative support for program development.
Requirements
  • Work requires written and oral communication skills, the ability to compose correspondence, comprehensive knowledge of behavioral health billing requirements, and strong computer skills in Excel and Word.
  • Work requires interpersonal skills sufficient to communicate effectively with P.A. clinicians, Division Directors, contracted clinicians, members of the insurance/managed care community, and other internal staff.
  • Work requires proven project/program and problem-solving administrative skills using Word, Excel, ECHO, and IDX.
  • Work requires proficiency with ECHO database to effectively record information and produce reports according to managed care specifications.


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