Clinical Health Network For Transformation (CHN) · 5 days ago
Credentialing & Licensing Specialist
United States
Full-time
Remote
Mid Level
$22.37/hr - $33.56/hr
3+ years exp
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Responsibilities
Complete, monitor and follow-up as needed, provider credentialing and recredentialing applications with all commercial, Medicaid, Medicare, and Medicaid managed care payers
Provide all payers with demographic updates when providers are added or terminated
Create, update, and maintain CAQH Provider data base accounts for clinicians, physician assistants and physicians. Acquire accounts for new providers (APRNs, PAs and physicians) not previously registered with CAQH
Obtain, update, and maintain the National Plan and Provider Enumeration System (NPPES) / Provider Enrollment, Chain and Ownership System (PECOS) accounts for all APRNs, PAs and physicians
Maintain electronic copies current state licenses, Board certification, DEA registration and CSR (LA only) certificates, malpractice coverage and any other required credentialing documents for all providers
Apply for malpractice coverage for new providers (APRNs, PAs and physicians), including off-site emergency coverage for physicians. Annually review the malpractice coverage for all providers with Affiliate Risk and Quality Management or designee
Develop and maintain instructions for current health plans and federal/state agency requirements for credentialing providers in each health plan or program
Maintain electronic folder of signed physician contracts including archived contracts
Manage and maintain confidentiality of provider information, including corporate related information needed for federal/state agencies
Creates and promotes a culture of continuous improvement
Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
Provides positive and development feedback and accountability related to practices including, but not limited to, equity
Qualification
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Required
Bachelor’s degree and three years of related experience with credentialing providers in a medical practice, with the accompanying knowledge and understanding of the credentialing process with health insurance plans and use of CAQH, or the equivalent combination of education, training, and related experience
Strong analytical and problem-solving abilities
Proficiency with Microsoft software (Excel, etc.)
Must be able to create and edit fillable forms in Adobe Acrobat
Ability to handle highly confidential and sensitive matters and documents
Ability to define problems, collect data, establish facts and draw valid conclusions
Ability to interpret an extensive variety of technical instruction in mathematical or diagram form and deal with several abstract and concrete variables
Knowledge of business practices and protocols
Ability to demonstrate initiative and to work with minimal direction
Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
Demonstrated dedication to Planned Parenthood’s mission, vision, and values
Strong interpersonal skills and the ability to build relationships with stakeholders
Excellent time management, and problem-solving skills
Preferred
Certified Provider Credentialing Specialist Certification (CPCS)
Experience working with state Medicaid programs is highly desirable
Strong working knowledge of professional billing software applications
Two to Five years billing office experience
One year’s data reporting experience
Benefits
Health Care Coverage (Medical, Dental, & Vision); eligibility for full-time, regular employees on date of hire
Flexible Spending Accounts and Health Savings Account
Short-Term Disability and Basic Life & AD&D Insurance provided by CHN
Voluntary elections for Long Term Disability and Additional Life & AD&D Insurance available at cost
Employee Assistance Program
Retirement Plan, 3% employer match after one year of service
Paid Time Off Program includes accrual-based PTO, Health Time Off (HTO), and nine (9) paid Holidays
Company
Clinical Health Network For Transformation (CHN)
CHN (an ancillary organization of Planned Parenthood) is a managed services organization that will provide an expansive suite of integrated standardized shared services and manage the Clinically Integrated Network (CIN) formed to improve quality care delivery, generate additional revenue, and reduce overall cost.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Lee Bower, CPA
Chief Financial Officer
Aaron Caine
Interim Chief Information Officer
Company data provided by crunchbase
