Credentialing Specialist in Franklin, TN at Acadia Healthcare

Date Posted: 11/6/2018

Job Snapshot

Job Description


Credentialing Specialist


The primary duty of the Credentialing Specialist is to provide support and guidance to facilities in all areas of the credentialing portion of the Managed Care/Contracting process. They will partner with facilities to assist in the preparation of the proper documentation for submission to meet the deadlines required. They will also assist in the review of paperwork for Medicare, Medicaid, and Commercial Payor compliance of documents for the organization.  Credentialing Specialist maintains the department work flow to ensure accuracy and completion of tasks in a timely manner. 

  • Assist in the preparation of applications for physician and facility participation in payor programs, including Medicare 855A, 855B, 855I and 855R and similar applications for Medicaid programs and Managed Care plans.
  • Track and monitor facility entries in Medicare’s PECOS database.
  • Maintain contracting database to monitor facility compliance with medical licensure, DEA, and Certificate of Insurance/Malpractice coverage. Run reports to monitor compliance and address non-compliance in a timely and proactive manner.
  • Assist facility credentialing leads in the preparation of Disclosure of Information documents requiring corporate validation and signature.
  • Prepare and submit initial state Medicaid enrollments and re-validations.
  • Prepare and administer facility information to the NPPES website. This will include both initial NPI’s for facilities as well as Group NPI’s for physician billing.
  • Communicate credentialing process related to the Credentialing Database in SharePoint and coordinate the sharing of information as needed to internal business teams.
  • Work closely with Corporate Director of Managed Care to ensure efficiency of processes and create new work flow tools as needed.
  • Travel as needed to assist the Managed Care department in trainings, presentations and payor related meetings.
  • Maintain preferred vendor relationships and manage vendor requests as it relates to credentialing information.
  • Identify and communicate to leadership identified risks posing negative compliance and/or financial impact
  • Other special projects or duties as assigned.

Job Requirements

  • BA/BS degree preferred but not required.
  • Hospital Credentialing experience required.
  • Certified Provider Credentialing Specialist (CPCS) certificate preferred or willingness to sit for CPCS within one (1) year of hire.
  • One - Three years current provider credentialing experience required. Behavioral Health experience preferred.
  • Basic to working knowledge of Centers for Medicaid and Medicare and Managed Care concepts including Managed Medicare/Medicaid requirements, Disclosure of Ownership and Control Interest, and applicable laws/statutes/regulations.
  • Experience working with hospital contracts or demonstrated knowledge of contract principles, and interpretation of contract language.