Credentialing Coordinator Job Houston area,Texas USA,Healthcare

Cenikor is a non-profit organization and one of the largest substance abuse treatment centers in the nation. We are currently seeking a Insurance Billing Specialist for our Corporate office in the Memorial area of Houston, TX.

Cenikor's Value Proposition
- What's In It for You?

PURPOSE in your work - service to others, giving back to your community, helping to save lives, being fulfilled at work.
COMPETITIVE PAY, BENEFITS, PAID TIME OFF, $2k - $4k TUITION REIMBURSEMENT, up to 10% 401K and BONUSES - we hire and reward high performers.
STABILITY and GROWTH - more than 55 years in business - our strong financial processes support our drive to serve more people and ensure stability for our team members.
CONTINUOUS LEARNING and PROFESSIONAL DEVELOPMENT - we are committed to developing our leaders in their desired career path and promoting from within. We have Cenikor Career Pathways Program that you can join after 90 days of employment. We also have an annual leadership development program with assigned mentors to help you achieve your professional goals.
The work we do isn't easy. If you like to work hard, to serve others and to have FUN with your team while achieving goals, Cenikor will be the right place for you!

Schedule:

Monday
- Friday 8am-5pm

ESSENTIAL FUNCTIONS:

1.Perform primary source verification (PSV) of credentials, including licenses, certifications, education, and training. This requires direct contact with state licensing boards and educational institutions.

2.Track, organize and process documentation and activities related to the organization's contractual arrangements with third party payers.

3.Maintain and update credentialing, applications, documentation, licenses, etc., and perform meticulous accurate, high-quality audits and review those items, systems, and contracts.

4.Communicate with the Payer Relations Manager to optimize communication with third party payers and facilities related to managed care credentialing applications, status, missing information, contracting, re-credentialing, and payer maintenance.

5.Maintain NPI registry with updated demographics for facilities and all clinicians within the foundation.

6.Monitor and ensure compliance with third party payer contractual obligations and timely credentialing and contract renewals. This includes effective communication with internal departments and staff to prevent the lapses of current contracts and completing credentialing and onboarding of new third-party payer contracts to include, but not limited to, commercial insurance, Medicaid, and other third-party payers.

7.Ensure the facility and all clinical personnel comply with federal, state, and local regulations, as well as the standards of accrediting bodies like The Joint Commission, CARF and NCQA.

8.Provide support related to arrangements and schedules for audits.

9.Maintain executed payer contracts and files, database with agreements summaries, completes documentations for payer agreements, onboarding, and maintain contract share drive, & database.

10.Maintain ongoing compliance with all required training courses relevant to the role, including but not limited to company-mandated courses and any state-regulated certifications or training requirements.

11.Ensure completion of Big 5 performance management tool by the required deadlines and use of SMART goals to support annual performance compensation review.

12.Adhere strictly to HIPAA regulations in regards to client confidentiality. Maintain strict confidentiality on all Foundation matters and refer questionable issues to your supervisor.

13.Uphold the core principles of Cenikor's culture and contribute to a positive working environment for all team members.

14.Perform additional duties as assigned and consistent with the non-exempt functions as defined in this job description.

QUALIFICATIONS FOR THE POSITION:
Skills, Knowledge and Abilities:

Skilled in administrative and clerical procedures.
Skilled in Microsoft Office and ten-key.
The ability to possess excellent organization and communication skills.
Ability to be detail oriented and accurately record numerical data.
Ability to possess a attitude.
Ability to work in a team environment.
Knowledge of Microsoft Office software required, including specific MS Outlook calendar experience.
Ability to consistently uphold the Core Principles of Cenikor's Culture:

Demonstrate mission of service to our clients
Positive, respectful communication with both staff and clients
Demonstrate self-motivation and perseverance to achieve goals
Role model appropriate, professional behaviors including appropriate client boundaries
Work effectively as part of a team, helping to set up others for success

Education:

High School Diploma or GED required
Associate degree or higher preferred

Experience:

One to three years of experience with Medicaid & Medicare
Two to three years of experience in healthcare setting reviewing contracts, billing, contracts and handling credentialing processes.

Physical Requirements:

Sitting in a normal position for…