Job Description

Job Description

Job Description

SUMMARY:

The Credentialing Specialist is responsible for ensuring that all therapists and licensed clinical staff are timely credentialed with all payer sources in compliance with internal policies. This role plays a vital part in maintaining credentialing, supporting the organization's ability to provide uninterrupted clinical services across all programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Essential duties include the following but not considered an inclusive list.

• Coordinate initial credentialing and recredentialing processes for all licensed and certified clinical staff (e.g., therapists).

• Complete, track, and maintain applications and enrollment for Medicaid, Medicare, and all commercial insurance plans.

• Maintain and update provider files, ensuring all required documentation is current and compliant with state, federal, and accreditation standards.

• Monitor license expiration dates and CEU requirements, providing timely reminders to providers and supervisors.

• Collaborate with Human Resources and Program Directors to ensure timely onboarding of new hires and credentialed staff.

• Respond to inquiries from insurance companies, clinics, and internal departments regarding credentialing status.

• Maintain accurate data in credentialing databases and software (e.g., CAQH, NPI Registry, Modio, PECOS, and payer portals).

• Support audits and site visits by preparing credentialing files and documentation.

• Assist with the development of credentialing policies, procedures, and workflows to improve efficiency and compliance.

• Ensure the confidentiality of all provider records and credentialing information.

• Ability to work with minimal supervision.

• Customer service driven with the ability to work as a team member.

• This is a safety sensitive position.

Maintains confidentiality of all information received regarding Friendship Community Care, Inc., and our clients. Conditions of confidentiality shall follow Friendship Community Care Non-Disclosure Policy and HIPAA Policies.

This job description is not intended to be all inclusive, and employee will also perform other reasonable related business duties as assigned by immediate supervisor and other management as required.

This organization reserves the right to revise or change job duties as the need arises. This job description does not constitute a written or implied contract of employment.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Minimum of High School Diploma or G.E.D.
• Must be proficient in basic Microsoft Office products.
• Any similar combination of education and experience
• Associate degree (A.A.) or equivalent from two-year college or technical school; or 6 months 1-year related experience and/or training preferred.

EDUCATION and/or EXPERIENCE:

• Two years related experience and/or training; or equivalent combination of education and experience. Degree preferred but not required.
• Experience in Credentialing databases such as, CAQH, Modio, MMIS, NOVITASPHERE, NPPES, PECOS is a plus.

LANGUAGE SKILLS:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental relations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of employees and managers.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Extensive knowledge of computer software including Windows Word, Excel, PowerPoint.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel objects, tools, or controls and talk or hear. The employee frequently is required to stand, walk, and reach with hands and arms. The employee is occasionally required to sit; climb or balance; stoop, kneel, crouch, or crawl; and taste or smell.

The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision, depth perception, and the ability to adjust focus.

QUALITY ASSURANCE & COMPLIANCE:

To adhere to the following and comply with all Quality Assurance's & HIPAA procedures:

The Code of Conduct and Compliance Investigation Procedures as read and discussed in the new employee training must always be followed.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Valid Driver's License, Clear Background and Drug Screen

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