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Credentialing Compliance Coordinator

2 months ago

Philadelphia, United States Comhar Inc. Full time

About COMHAR, Inc.

At COMHAR, our mission is to deliver health and human services that empower individuals, families, and communities to achieve healthier, self-determined lives. We offer a comprehensive range of recovery-oriented and quality-focused services, from outpatient treatment to residential and day programs, all designed to provide high-quality support tailored to individual recovery journeys.

Position Overview:

The Credentialing Coordinator plays a crucial role in ensuring that all employees, contractors, and service providers at COMHAR, Inc. comply with the necessary credentialing standards required for service delivery. This position is tasked with the development, implementation, and maintenance of efficient processes for credentialing and re-credentialing. The Credentialing Coordinator will lead and oversee the monitoring and documentation of credentialing processes for all behavioral health professionals, ensuring adherence to funding source requirements and contractual obligations.

Work Schedule:

Monday to Friday, 8:30 AM to 4:30 PM (3 days in-office, 2 days remote)

Compensation:

$47,132.80 annually

Key Responsibilities:

  • Develop and maintain processes for monitoring and timely completion of credentialing and re-credentialing.
  • Lead and coordinate the review of applications and documents for health care and behavioral health practitioners to ensure eligibility.
  • Manage provider credentialing and privileging for Licensed Behavioral Health Professionals.
  • Identify and address issues requiring further investigation and resolution.
  • Investigate discrepancies and ensure timely follow-up actions.
  • Prepare credential files for timely completion and presentation to auditors.
  • Respond to inquiries from organizations and collaborate with internal and external stakeholders on credentialing matters.
  • Conduct internal audits and assist with managed care credentialing audits.
  • Verify pre-employment credentials, including certifications, licenses, education, and clearances.
  • Maintain confidentiality of all records and information while performing job duties.
  • Establish and uphold a schedule for audits across all programs.
  • Manage data entry and documentation within credentialing software.
  • Generate monthly reports on staff credentialing status.
  • Travel to various COMHAR locations for credentialing activities as needed.
  • Perform additional duties as assigned.

Qualifications:

  • High School diploma or GED required.
  • Minimum of 2 years of relevant credentialing experience in health care or human services.
  • Proficient in Microsoft Office Suite (Word, Excel) and HRIS systems.
  • Understanding of full cycle credentialing and re-credentialing processes.
  • Familiarity with Medicaid, Medicare, and Managed Care organizations.
  • Knowledge of clinical operations and procedures.
  • Database management skills, including querying, reporting, and document generation.

Equal Employment Opportunity:

COMHAR, Inc. is proud to be an EEO employer M/F/D/V. 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 federal, state, or local law.