Credentialing Specialist

CLASSIFICATION/STATUS: Non-Exempt, Part Time, Permanent

IMMEDIATE SUPERVISOR: Director of Patient Accounts

SUPERVISORY RESPONSIBILITIES: None

SALARY: Band 3: ($22.00-$30.50/hour)

WHO YOU ARE:

YOUR ROLE & IMPACT

The mission of Charles River Community Health (CRCH)is to partner with individuals and families so they can thrive and lead healthier lives by delivering the comprehensive, integrated, and equitable primary healthcare that matters most to them. The Insurance Credentialing Specialist is responsible for managing the credentialing process for healthcare providers, ensuring compliance with all regulatory requirements. This role involves initial application completion, ongoing maintenance, and communication with external credentialing personnel and insurance companies.

RESPONSIBILITIES:

• Complete initial request for application prior to provider’s first day of employment.

• Assist with CAQH enrollment.

• Assist providers with obtaining NPI (National Provider Identifier) numbers.

• Review packet once received, completing and answering all questions pertaining to the Health Center, Health Center information (i.e. TIN, NPI, etc).

• Facilitate provider signatures and document completion.

• Follow-up with providers until application packets are returned.

• Attach supporting documents, email to insurance companies and update internal tracking system.

• Address additional inquiries or requests from external from external credentialing personnel.

• Update internal tracker upon obtaining privilege's from insurance companies.

• Initiate and follow up with all insurance companies outside of Beth Israel Lahey Health Performance Network (BILHPN) to obtain credentialing as soon as possible.

• Maintain detailed notes and communication regarding payer actions and request.

• Provider monthly status updates to operations regarding providers and payers.

• Maintain CAQH Re-Attestation.

• Maintain Provider and Health Center Directories up to date.

• Work directly with HR to maintain licensure information current.

• Other responsibilities as requested.

Qualifications, Traits, and Competencies:

• College courses or degree in related field, or equivalent work experience.

• Prior knowledge of principles and practices of human resources and experience with an CAQH database preferred.

• Familiarity with medical billing preferred.

• Demonstrated proficiency and experience with Microsoft Office, including Microsoft Word, Excel and Outlook essential.

• Highly organized, detail oriented, and able to work under pressure and meet deadlines.

• Strong interpersonal and communication skills required.

• Prior experience in a health care setting and in diverse culture preferred

WHO WE ARE & WHAT WE DO

Charles River Community Health’s mission is to partner with individuals and families so they can thrive and lead healthier lives by delivering the comprehensive, integrated, and equitable primary healthcare that matters most to them.

CRCH is a comprehensive practice providing medical, pharmacy, dental, behavioral health, optical, and vision services to diverse underserved local communities. We serve over 13,500 patients annually, and 90% of those served are low income, while over 70% need services in a language other than English.

We are committed to providing patients with timely access to the right care, at the right place and at the right time, collaborating with other organizations to connect patients with a comprehensive range of services and provide continuity of care, and creating new community partnerships to meet the changing needs of patients and the community.

We value caring for everyone with dignity, respect, and compassion, reducing cultural, financial and other barriers to care, and eliminating health care disparities for our patients. We also advocate for the needs of our patients, the community, and public health causes.

OUR PROMISE

If you are passionate about providing service excellence in a mission-driven, team-oriented, and progressive organization, you will find your career as Behavioral Health Outpatient Clinician rewarding and impactful! You will also find a partner in your career path goals and trajectory!

OUR BENEFITS & PERKS

Medical, Vision, & Dental Insurance

Short & Long-term Disability, and Life Insurance

Generous Paid Time Off

Flexible Spending Account

Employee Assistance Program

Tickets at Work

Health Reimbursement Arrangement

Travel Reimbursement

Professional Development Opportunities

Solid track record of developing and promoting employees internally!

Charles River Community Health is strongly committed to diversity and a workplace environment that respects, appreciates and values employee differences and similarities. By providing and supporting a work culture that fosters and builds upon diversity and its strengths, CRCH will better serve our local communities and continue to provide quality patient care and services. CRCH is an employment at-will organization and an equal opportunity employer committed to maintaining a work and learning environment free from discrimination on the basis of sex, race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, CRCH prohibits retaliation against an applicant or employee because he or she has engaged in protected activity under the statutes prohibiting discrimination in the workplace.