Credentialing Specialist

Employer: Foresight Mental Health

Welcome to Foresight Mental Health. We’re so glad you’re considering joining our team.

Explore your passion for mental health while being part of an innovative community that’s transforming the delivery of mental health care.

In this role, you’re responsible for helping bring on our new providers, from intake to contract completion. You’ll credential, recredential and ensure providers are enrolled with our contracted insurance payers by completing primary source verifications, submitting applications, and tracking each provider’s progress. And you’ll work with providers to maintain their credentials, licenses and any other applicable certifications required for the provider to legally work and practice their specialty in their state.

This is a full-time, hourly position.

What you’ll do

• Gather, review and evaluate highly confidential and sensitive health care practitioner credentials consistent with departmental policies and guidelines and NCQA standards
• Initiate and manage the initial credentialing and recredentialing processes for providers, from intake through contract completion/renewal
• Prepare complete provider credentialing/recredentialing files for internal Credentials Committee review and approval
• Proactively follow up with insurance payers to track application or enrollment progress and respond to payer requests and inquiries in a timely manner
• Monitor expiring licensure, board and professional certifications and other expirable documents within the prescribed time frame
• Conduct ongoing sanctions and compliance monitoring and alert Manager(s) of any undisclosed negative findings immediately
• Maintain provider files and demographic information by submitting changes and removals to insurance payers and updating internal tools and CAQH
• Accurately enter and maintain provider and payer data in applicable database(s) to ensure the integrity of credentialing information
• Serve as point of contact for credentialing-related questions from providers and internal teams, and for credentialing-related discrepancies with insurance payers and external partners
• Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency

What you’ll bring

• Bachelor’s degree or equivalent experience preferred
• Minimum 2-3 years of experience with provider credentialing, including utilization of CAQH
• Experience should include responsibility for credentialing processes, policies and procedures, as well as familiarity with NCQA standards and delegated credentialing requirements
• Proficiency with Google Suite and/or MS Office Suite
• Access to a private workspace that complies with the Health Insurance Portability and Accountability Act (HIPAA) privacy guidelines
• Certified Provider Credentialing Specialist (CPCS) qualification a plus, but not required

What you’ll receive

• This is a full-time remote position that pays $23-25 per hour
• Comprehensive medical, dental and vision coverage
• Paid time off, sick time, paid holidays
• 401k with employer match

Come join our dynamic and innovative team working toward mental wellness for all.

APPLY HERE