Credentialing Coordinator

About this opportunity:

Workplace Options is proud to support our sister organisation, Behavioral Health Systems (BHS), in recruiting a Provider Relations Credentialing Coordinator. This is an exciting opportunity to contribute to a growing organization, ensuring strong provider partnerships and the highest credentialling standards.

BHS operates one of the nation's largest specialty preferred provider organizations (PPO), which is comprised of psychiatrists, psychologists, social workers, EAP providers as well as facility networks including hospitals, rehab/residential treatment centers, partial hospitalization programs and intensive outpatient programs. BHS fully credentials and panels their own network of providers.

Current Opportunity:
Provider Relations Credentialing Coordinator

Location:

Alabama (Birmingham)

Full-time/Part-time:
This is a full-time (40 hours per week) position.

What you will do:

Reporting to the Vice President, Provider Relations, and with general responsibility to the Provider Relations division, this position is responsible for researching and resolving claims issues, managing credentialing and referral agreements, initiating and reviewing provider credentialing processes, and maintaining accurate provider data systems. It also serves as a liaison between Credentialing and other internal departments.

Responsibilities:

* Research and resolve claims and the related issues as requested by Claims Administration.

* Enter Case Specific Agreements into MCS.

* Enter Referral Agreements into MCS.

* Initiate (re) credentialing process upon receipt of application. Review provider and primary source responses. Refer all responses not meeting BHS credentialing criteria to Vice President, Provider Relations.

* Maintain computerized provider system, including preparing data conversions for network providers, and entering current credentialing/quality assurance information.

* Work with Network Development/Clinical/Claims Administration whenever they have questions regarding claims and need information and assistance in getting the claims entered and/or approved.

* Act as the primary liaison between Credentialing and other divisions within the company whenever there are questions to include responding to or routing emails and/or phone calls to the appropriate parties, researching and/or resolving provider credentialing-related issues, and managing tasks submitted through internal provider management system.

* Learn all other Credentialing Specialist job duties.

* Prepare reports as requested.

* Attend quarterly credentialing committee meetings, as requested.

* Maintain all information in a confidential manner.

* Adhere to established policies and procedures as directed.

* Perform other related duties and special projects as directed.

Qualifications/

Skills:

* High school diploma, some college preferred

* 3 years extensive data entry experience

* Minimum 60 WPM typing

* Proficiency in MS Word and Access required

* Advanced PC computer software skills (i.e., spread sheets, special programs)

* Accuracy and attention to detail

* Excellent proofreading skills

* Good organization and written communication skills

* Ability to meet deadlines/handle interruptions/problem-solve

* Cooperative attitude and self-starter

* Superior disposition and telephone communication skills

* Dependability and punctuality

* Ability to work with a minimum of supervision

* Alabama driver's license and dependable transportation

* Provider credentialing or provider systems experience (or related provider relations experience) required

For further information about BHS please see