What are the responsibilities and job description for the Credentialing Specialist position at West Michigan Community Mental Health System?
Annual Salary Pay Range: $44,576 - $62,836
The Credentialing Specialist is responsible for performing specialized functions within the human resources department. Specific areas of responsibility include credentialing functions ensuring WMCMH has established practices and procedures aligned with policies to ensure compliance. This includes direct responsibility for credentialing staff and contracted providers, ongoing monitoring of credentialing processes and ensuring standards are kept up to date with all requiring bodies, and timely provider set up in electronic records systems. The individual in this position is also responsible for preparing for audits and assembling requirement documentation. The position will assist with other human resources duties as assigned.
JOB DUTIES:
- Performs Credentialing Checks/Verifications: Obtains required documents for credentialing process, ensures timely enrollment in systems. Conducts preliminary credential checks for new hires and internal transfers to ensure credentialing standards are met.
- Maintains databases: Performs all steps in the Universal Credentialing process for credentialing. Updates all systems including clinical staff listings, R3, and other required systems with all credential updates.
- Processes documents: Prepares and processes all documents for Universal Credentialing, internal credentialing and WMCMH Credentialing & Privileging Committee.
- Ensure accurate files: Maintains, manages and processes all credentialing forms in required files and employee’s personnel files and other required systems.
- Compliance: Understands credentialing requirements for providers as it pertains to regulatory bodies as well as Medicaid billing requirements. Ensures all required background and credential checks are timely and accurate. Ensures professional licenses and/or other required licenses/certifications are maintained. Provides notices to employees on upcoming expiring documents to ensure no lapses occur.
- Insurance: Coordinate with the Billing and Reimbursement teams to ensure necessary documents and licensure are in place for enrollment with insurance payors.
- Maintains job descriptions: Ensures job descriptions are up to date and align with regulatory body standards. Processes and files all job descriptions. Ensure signatures on updated descriptions are obtained and files in employee’s personnel records.
- Other: Makes recommendations for policy, procedural, and/or process changes to align with regulations changes. Sits on the Credentialing & Privileging Committee to process decisions made in regard to credentialing. Maintains expertise in primary credentialing functions including initial credentialing, re-credentialing, policy and procedures and electronic health record standards.
Salary : $44,576 - $62,836