Credentialing Specialist (62420)
If you are looking for a career with a company whose focus is to create opportunities for and with people, RISE is the company for you.
RISE is an innovative human services network originally established in 1987 for the purpose of moving individuals living in institutions into family settings. Since that time, services have grown to support children, adults, and families with a variety of needs across multiple states that include residential settings, day programs, employment assistance, managed care, home and community based services, family services in foster care, adoptions and family preservation and early intervention services. Since inception, our purpose and mission has remained constant.
We create opportunities for and with the people we serve, their families, and for the men and women who work for RISE family of companies.
Seeking to hire an experienced Credentialing Specialist to join RISE at our conveniently located administration office in Mesa, AZ.
The Credentialing Specialist will be responsible for maintaining active status of providers and clinic facilities by preparing and maintaining documentation and reports of credentialing activities such as accreditation and licensing. The incumbent will ensure that all information meets regulatory guidelines when processing credentialing applications, assist with audits and inquiries and keeping our Therapy clinic accreditations up to date.
ESSENTIAL JOB FUNCTIONS:
- Responsible for oversight of all credentialing activities
- Credentialing and re-credentialing of providers to various health plans
- Performs initial review of new payer contracts and suggests changes to discuss with Director
- Maintain provider profiles including credentials and licensing to ensure active status with various health plans
- Enroll new providers in various health plans
- Expand business network of credentialed health plans
- Experience with credentialing for OT/PT/ST and ABA preferred
- Knowledge of medical billing and ICD-10, and CPT coding
- Experience working with Public, Private Payers, Commercial and Medicaid
- Knowledge and/or experience of the health plan websites such as CAQH, Availity, CMS Medicare (PECOS), NPPS (NPI), state licensing boards and National Provider Data Bank
- Associates degree in Healthcare or Business Administration or equal experience in Medical coding
- 2 years credentialing experience is required and up to 5 years credential experience is preferred
- 2 years experience in a medical practice business office role required
- Accurate and timely data entry
- Ability to work independently and as a team player
- Excellent time management and organizational skills
- The ability to type and enter data quickly, at a rate of around 50 words per minute is also highly desirable
- Associates degree in Healthcare or Business Administration or equal experience in Medical coding is preferred
- Medical coding certification issued by NAMSS is preferred
- Intermediate Microsoft Excel experience is preferred
We offer a generous benefits package including paid time off, medical, dental, vision, retirement plan and more.
If you require reasonable accommodation for any part of the application process or hiring process, please submit your request through one of the following methods listed below:
(a) Dedicated fax 866-268-8885
(b) Dedicated email firstname.lastname@example.org
(c) US mail
(d) Dedicated phone - 1-866-242-2714: DISABILITY ACCOMMODATION REQUESTS ONLY
RISE is an Equal Employment Opportunity (EEO) employer. We embrace diversity in all its form. We provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.