Credentialing Specialist

Our MindClub America team believes in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare.

We are actively looking for an experienced credentialing/contracting specialist to conduct credentialing activities and to assist in other areas such as recruiting efforts and overall revenue cycle management. An ideal candidate for our credentialing position typically possesses a blend of specific skills, qualifications, and experience that aligns with the responsibilities of the role. Here are some of the key qualities:

· Attention to detail

· Organizational skills

· Knowledge of credentialing and compliance standards

· Communication skills

· Problem -solving abilities

· Confidentiality and integrity

· Experience in healthcare services.

We pay attractive rates and have an attractive benefits package for full-time employees.

Duties of this position include, but are not limited to, the following:

Position purpose

Process credentialing and re-credentialing and associated tasks in accordance with MindClub America’s policies, standard operating procedures and regulatory requirements.

Responsibilities/Duties/Functions/Tasks:

· Manage all initial and reappointment credentialing items for all providers.

· Collaborate with Human Resources for new provider onboarding

· Gather and submit in appropriate format required credentialing information for assigned provider/practitioner network

· Collect and submit all malpractice information and ensure up to date COIs on all providers

· Collaborate with provider organizations to facilitate timely and effective credentialing of assigned provider/practitioner network

· Monitor and update provider and practitioner status and associated information as appropriate

· Maintain accurate data base, tracking files, etc., for assigned provider/practitioner network

· Conduct primary source verification as appropriate

· Provide accurate and informative status reports

· Continuously track and monitor credentialing status and credentials to ensure accuracy and identify re-credentialing needs

· Ensure compliance with MindClub America policies and procedures as well as established regulatory and contractual requirements

· Conduct thorough review of all credentialing information to ensure compliance with policy, regulatory and contractual requirements

· Maintain corporate provider contract files.

· Maintains knowledge of current health plan and agency requirements for credentialing providers.

· Set up and maintains provider information in online credentialing databases and system.

· Tracks license and certification expirations for all providers to ensure timely renewals.

· Ensures practice addresses are current with health plans, agencies, and other entities.

· Other duties as assigned.

Qualifications

Education: High school diploma or equivalent.

Experience: Minimum three years of preferred credentialing experience.

Additional Preferred Qualifications:

Understanding delegated credentialing requirements for the health plans.

· Understanding of national accrediting entities (NCQA)

· Understanding of commercial insurance, Medicare and Medicaid enrollment processes

· Understanding of credentialing terminology

· Experience with primary source verification and associated credentialing sources

Performance Requirements:

· Strong presentation skills

· Excellent communication skills, both written and verbal

· Ability to work with physicians and non-physician providers in a fast-paced environment

· Proficient computer skills (Microsoft applications)

· Ability to multi-task and prioritize

· Self-motivated with initiative; willingness to learn and adopt new strategies

· Strong sense of ethics.

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Work Location: Hybrid remote in Franklin, TN 37067