Managed Care Credentialing Specialist - Part Time Position

Position Overview:

The Managed Care Credentialing Specialist is a Part-Time Position that will play a critical role in ensuring that our home health and hospice clients comply with all regulatory and accreditation requirements. This position requires a strong understanding of managed care processes, a keen eye for detail, and excellent organizational skills. The ideal candidate will be responsible for managing the credentialing process for clients and ensuring that all necessary documentation and data are accurately maintained.

Responsibilities and Expectations:

• Oversee and coordinate the credentialing and re-credentialing processes for agencies in alignment with state and federal regulations.
• Collect, verify, and maintain comprehensive records of all credentialing documentation, including licenses, certifications, and other required documents
• Collaborate with team to ensure timely submission of credential applications to insurers and payers.
• Monitor and track credentialing expiration dates, ensuring timely renewals and compliance with all managed care contracting requirements.
• Conduct regular audits of credentialing files to maintain accuracy and completeness.
• Coordinate with insurance payers to resolve any discrepancies or issues regarding provider credentialing and contracting.
• Maintain updated knowledge of regulatory changes and best practices in managed care credentialing, home health, and hospice operations.
• Prepare and submit periodic reports on credentialing status and metrics to management.
• Act as a liaison between staff, management, and health plans regarding credentialing inquiries.
•  Assist with onboarding clients. Due diligence verifying credentialing documents and setting up in portal
•  Compile and submit initial enrollment and revalidation applications for managed care payers, ensuring accuracy and attention to detail
•  Maintain accurate enrollment records and communicate updates to internal stakeholders
•  Create timely reports for managed care payers and perform routine audits to ensure compliance
•  Coordinate with providers to ensure accurate credentials and streamline communication
•  Act as a liaison for external privileging with other organizations, ensuring compliance with contractual obligations
• Ability to work 20 hours per week.
• Additional responsibilities as position grows.

Qualifications:

• Prior experience in credentialing within the healthcare industry, particularly in home health and hospice settings. (preferred)
• Familiarity with managed care and healthcare operations and regulations.
• Exceptional attention to detail and strong organizational skills.
• Proficient in data entry and management, with a strong command of Microsoft Office Suite (Excel, Word, etc.).
• Excellent communication and interpersonal skills, with the ability to work collaboratively across various teams.
• Ability to handle sensitive information with confidentiality and professionalism.
• Strong problem-solving skills and the ability to work independently.
•  High school diploma, GED, or equivalent required
•  Experience in healthcare, with proficiency in Microsoft Office and Excel preferred
•  Excellent customer service, time management, and communication skills (oral and written)
•  Strong organizational skills and attention to detail.
•  Ability to multitask on various projects while meeting different deadlines.

How To Stand Out (Preferred Qualifications)

•  Experience in healthcare revenue cycle preferred
•  Analytical skills with the ability to research and translate information into actionable items

Healthcare Provider Solutions is an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic, information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.