Position Summary
This role is responsible for implementing credentialing guidelines for clinical and field-based personnel set by Centria Healthcare, Community Mental Health organizations, insurance companies, and other agencies. The Credentialing Specialist organizes, maintains, and verifies files on clinical and field-based staff, ensuring they are compliant and always available and eligible to provide client services. Additionally, they will provide a positive customer service experience to team members, including clinical, field staff and payors, by being the point of contact and assisting them with related inquiries.
Success measures include adherence to Centria policies, flawless execution of tasks, and meeting or exceeding personal qualitative and quantitative key performance indicator (KPI) metrics such as customer satisfaction, meeting targeted credentialing measures for active and on-hold team members and internal and external audits.
Duties and Responsibilities
The below reflects the essential functions considered necessary for this role and shall not be construed as a detailed description of all work requirements inherent in the job or assigned by supervisory personnel. This job description is used as a guide only and not inclusive of all responsibilities and job duties.
- Team Member Credentialing
- Alert and enroll clinical and field staff in required training courses based on the payor, state, and federal regulations and track completion.
- Review documentation for accuracy and ensure credentialing with Centria, payor, state, and federal mandates.
- Track clinical and field staff credentialing and communicate to the appropriate individuals to ensure receipt before expiration.
- Update internal and external systems with credentialing documents.
- Communicate credentialing deadlines with the Operations Team at established milestones and escalate as needed to prevent team members from going on hold.
- Perform dormant team member follow-up and offboarding tasks as needed and in credentialing with Centria guidelines.
- Document and Data Integrity and Reporting
- Remain current with changes in payor regulations and related operational processes.
- Assist with audits from external and internal sources and ensure timely completion.
- Provide documentation, status updates, and reports on clinical and field staff credentialing to other departments and leaders as needed or requested.
- Customer Service
- Serve as a resource for team members with questions regarding Centria guidelines, payor requirements, etc.
- Follow-up via email or service desk with team members within 24 hours and maintain a customer satisfaction rating above 90%.
Education
- Associates Degree
- Bachelor’s Degree, preferred
Work Experience
- 1 + years administrative or customer service experience
- Data entry experience, required
Equipment and Technology Experience
- Laptop or Desktop computer
- G Suite (Gmail, Drive, Docs, Sheets, Google Meet)
- Microsoft Office Suite (Word, Excel)
Knowledge and Skills
- Proficiency in PC software, especially spreadsheet programs;
- Effective communication skills, both written and verbal, with internal and external stakeholders;
- Ability to build rapport with team members, including clinical and field staff, explain complicated information in an approachable and easily understood manner, effectively handle challenging phone conversations, and represent the Centria brand;
- Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks;
- Proven adaptability with a willingness to work both collaboratively and individually to achieve desired business outcomes;
- Excellent interpersonal and listening skills;
- Demonstrated strong work ethic with attention to detail, accuracy, and quality;
- Established track record of generating error-free work.
Competency Requirements
An initial assessment of competency will be completed during the interview period and evaluated on an ongoing basis.
- Ability to follow written instructions
- Ability to use computers and computer/software programs
- Communication skills
Working Conditions
- Centria’s office hours are Monday through Friday from 8:30 am – 6:00 pm.
- Additional time or occasional shift in schedule may be required to complete the above work or meet company objectives.
- Overtime is not a planned part of this role; if required, overtime must be pre-approved in writing by a leader in the department.
Physical Demands
While performing the duties of this job, physical requirements such as bending, reaching, lifting, pushing, or pulling up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing periodically. This role may require close visual acuity on computer screens or monitors and the ability to analyze data and figures on a screen.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position. Centria reserves the right to amend this job description at any time, with or without written notice.
