Credentialing Specialist- Medical Facility
Behavioral Health Network, Inc.

Job Info

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Description

The Medical Facility Credentialing Representative is primarily responsible for tracking and submitting facility credentialing applications and maintaining an organized historical database of these applications for all payers contracting with BHN for its sites and programs. The Medical Facility Credentialing Representative will be evaluated on the ability to execute the responsibilities effectively and accurately while meeting established deadlines.

The Medical Facility Credentialing Representative is responsible for reviewing credentialing applications, updating, modifying, and accurately informing the representation of BHN's facility configuration to payers, as changes occur. The Medical Facility Credentialing Representative interprets facility licensure, payer program specifications, and CMS and MA Health contracting requirements. Finally, the Medical Facility Credentialing Representative must understand, appreciate, and protect the confidentiality of the personal information of individuals employed by and serving BHN.

ESSENTIAL JOB FUNCTIONS :

• Effectively manages a portfolio of third-party commercial insurance payers, CMS, and MA Health facility credentialing applications.

• Updates and maintains a database of fee schedules for the various credentialed insurers.

• Effectively time manages the receipt and submission of applications to payers based on each insurance company's cadence.

• Works with Program Leadership, the Clinical Director, and the Credentialing Department to obtain, update, and maintain current data to accurately represent BHN on credentialing and re-credentialing applications.

• Identifies credentialing issues, coordinates resolution, and takes corrective actions, as needed. Knows when to appropriately escalate issues to the Vice President

OTHER DUTIES AND RESPONSIBILITIES:

• Participates in updating the Credentialing department's Policies and Procedures related to facility credentialing.
• Other duties as assigned

QUALIFICATIONS

• Associate's degree with 5 years of experience in a facility credentialing/contracting department required. Bachelor's Degree with a minimum of 3 years' experience in a facility credentialing/contracting department preferred.

• Strong verbal and written communication skills.

• Strong reasoning, critical thinking, and analytical skills.

• Must possess extensive knowledge in the use of Microsoft Products: Outlook, Word & Excel, and Teams. Strength in accessing data via the Internet, ability to effectively use payer websites; familiarity with navigating POSC and PECOS.

• Demonstrated knowledge of Behavioral Healthcare credentialing and an understanding of facility credentialing for a Community Mental Health Center preferred.

• Understanding of the Behavioral Health Insurance environment in Massachusetts is strongly desired.
• Master's Degree in relevant field preferred.
• Ability to negotiate including effective communication, active listening, emotional intelligence, and expectation management, are helpful

How Do I Apply?

If you are interested in this opportunity, please click 'Apply for Job' below or visit our website at www.bhnworks.org and click on "Browse All Jobs" to apply!

BHN maintains its commitment to social justice and diversity and strongly encourages diverse candidates to apply.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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