Pathway Healthcare is a leading behavioral health organization dedicated to providing comprehensive care for individuals facing mental health challenges, and substance abuse issues. We believe in a holistic approach to treatment, addressing both physical and mental well-being to foster lasting recovery and wellness.

We value our team members and want our team members to experience a positive culture where they feel valued. Our team members have access to health benefits, including Teladoc that is free to all full-time employees, as well as PTO, and paid holidays. If you are passionate about helping people and want to be part of a team where you will be valued and have the opportunity to grow, then send us your resume!

POSITION OVERVIEW

The Credentialing Specialist is responsible for the credentialing, enrollment, and maintenance of all assigned providers and perspective payers. Maintaining providers files with up-to-date information and communicating needed information/updates to various departments in a timely manner.

ROLE RESPONSIBILITIES

• Ensure all provider enrollment paperwork is complete and submitted in a timely manner.
• Respond promptly to all insurance payer request or questions.
• Maintain provider CAQH, PECOS, credentials, and payer enrollments.
• Maintain all demographic and practice information with all payers.
• Communicate effectively with various departments including Revenue Cycle, Human Resources, Contracting, and others on the Leadership Team on a regular basis.
• Update spreadsheets as needed (i.e., credentialing status spreadsheet, CAQH spreadsheet, etc.)
• Continue the research of state specific credentialing requirements to ensure correct applications and processes are always met.

QUALIFICATIONS & EDUCATION REQUIREMENTS

• High School Diploma.
• Completion of an Associate’s degree or certificate program in a related field preferred however relevant experience may be substituted.
• Minimum of 2 years of insurance credentialing and enrollment experience required.
• Knowledge of Medicare and Medicaid is a must.
• Attention to detail.
• Must be highly organized.
• Knowledge of Microsoft Office applications and general computer literacy
• Excellent verbal and written communication skills.
• Ability and willingness to work as part of a team/
• Upbeat and self-motivated.