Description

Join Our Team as a Credentialing Specialist and Be a Part of Something Meaningful!

 Are you ready to embrace a role that combines hard work, a fantastic team, and a sense of purpose? We're looking for a Credentialing Specialist to play a pivotal role in maintaining the seamless provider enrollment process. Our team believes in the power of collaboration and is committed to meaningful work that makes a difference every day.

Compensation:

$45,000 to $50,000 annually

Generous Benefits including:

· Paid Medical, Dental, Vision

· 401k with company match

· HSA

· Paid Holiday, Vacation and Sick time off

· and more!

Location:

Silver Spring, MD, hybrid, or remote (central time zone okay)

About Us:

At PsychoGeriatric Services, we understand the importance of a well-functioning office environment. It's where the magic happens, where we come together as a team, and where we make a meaningful impact on the lives of our clients. We value hard work, dedication, and the importance of maintaining a friendly and professional atmosphere.

What You'll Do:

This role will credential/enroll practitioners for network participation with Medicare, Medicaid, CareFirst BlueCross BlueShield, Aetna, United Health, Cigna, Optum, Kaiser, Humana - Tricare and other payers. Must accurately organize and maintain all provider data while ensuring compliance with regulatory, accreditation, legal and company requirements and standards. 

What You'll Do:

This role will credential/enroll practitioners for network participation with Medicare, Medicaid, CareFirst BlueCross BlueShield, Aetna, United Health, Cigna, Optum, Kaiser, Humana - Tricare and other payers. Must accurately organize and maintain all provider data while ensuring compliance with regulatory, accreditation, legal and company requirements and standards. 

Credentialing Responsibilities:

• Responsible for credentialing/enrolling new providers and re-credentialing/re-enrolling existing providers for specific insurance companies assigned.
• Follow-up and ensure we are timely getting providers credentialed/re-credentialed.
• Respond to more complex external and internal inquiries regarding provider participation eligibility and criteria, provider data detail/structure, participation status, credentialing, contractual status, and provider file updates.
• Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved.
• Once verified, accepted and approved, determine the appropriate networks for participation.
• Assist with obtaining new payer contracts and review existing agreements to confirm language and appropriate fee schedules. 
• Maintain the provider file by utilizing the provider credentialing information system during processes, such as credentialing, re-credentialing, demographic updates, terminations, and all other provider file maintenance activities.
• Responsible for identifying, analyzing, and resolving immediate and existing provider file issues through telephone calls, email, and system routes from operational areas.
• Process provider file inputs in accordance with applicable state laws and departmental guidelines. Verification of provider data and system release entered the provider file database, ensuring successful integration with the other corporate systems.
• Prepare written responses to obtain incomplete or missing information and communicate effectively telephonically.
• Communicate tracked progress of credentialing into weekly report and/or meeting.
• Assist with facility credentialing as needed.
• Collaborate with the RCM team on credentialing issues.
• Ensure proper time management of all tasks.

 Experience:

• Minimum of 3 years of provider credentialing, with specific experience in behavioral health settings. 
• Knowledge of third-party carrier operating procedures and practices - particularly as they relate to levels and methods of reimbursement.
• Proven skill in defining problems, collecting data, interpreting information.
• Ability to examine documents for accuracy and completeness, to prepare records in accordance with detailed instructions.
• Proficiency in the use of a computer and calculator.
• Effective verbal and written communication skills.

Qualifications:

• High school diploma is required.
• Certified Provider Credentialing Specialist (CPCS) is preferred.
• Must be proficient in the use of Excel spreadsheets and understand pivot tables.
• Excellent verbal and written communication and interpersonal skills. Ability to develop and maintain effective relationships with peers, the leadership team, payer representatives, and medical staff to create confidence, respect, and dependability.
• An aptitude for both independent and collaborative work in a fast-paced environment.
• A commitment to discretion and professionalism when dealing with confidential information.
• Strong organizational and multitasking abilities to ensure efficient task management.
• Demonstrated proficiency in utilizing reference materials and ability to follow standard operating procedures to reduce risk and ensure provider data accuracy and overall quality.
• Ability to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions.

Typical Physical Demands:

Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, computer, and other office equipment is also required. Must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports.

Note: Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Why You'll Love Working With Us:

• Meaningful Work: At PGS, your efforts play a vital role in our mission, ensuring our clients receive the support they need.
• Great Team: Our team is important to us and we're here to support each other.
• Professional Growth: You'll have opportunities for professional development and career advancement.
• Work-Life Balance: We believe in taking care of our team, with flexible work arrangements to help you maintain a healthy work-life balance. Core Business hours M-F 8-6
• Benefits: We offer a comprehensive benefits package to support your well-being.

Apply today and be part of our mission to make a difference!

Requirements

• High school diploma is required
• CAQH Experience 
• CMD/EMR Systems Experience 
• Multi-State Credentialing Experience 
• Certified Provider Credentialing Specialist (CPCS) is preferred
• Must be proficient in the use of Excel spreadsheets and understand pivot tables