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Credentialing Specialist

Credentialing Specialist

Harbor, Inc.Toledo, OH, US
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Job Description

Job Description

Harbor is seeking a Credentialing Specialist to join our Toledo team! This position is responsible for the day-to-day operations of credentialing new and established health care providers and maintenance of clinical information and practice locations with payer sources in a timely and complete manner.

Position is full-time, 40 hours per week.

Education / Experience / Other Requirements :

  • Associate degree in administration, health or behavioral science field preferred.
  • Behavioral Health experience preferred.
  • Must have knowledge of medical terminology and at least two years of related experience.
  • Must have excellent communication skills, both verbal and written.
  • Must demonstrate an ability to meet deadlines in a multi-functional task environment.
  • Requires excellent organizational skills, an operational knowledge working with word processing, spreadsheets, data entry, electronic health record and practice management systems, and other computer related skills.
  • Must at all times maintain efficiency and timeliness in all daily activities.
  • Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
  • Provides optimal customer service to meet the organization’s expectations.
  • Must at all times be able to maintain the confidentiality of privileged information.
  • Excellent project management with ability to follow up on projects and meet deadlines.

Essential Job Competencies / Primary Duties :

  • Assists the Credentialing Coordinator in the day to day operations
  • Performs the appropriate credentialing and privileging processes for both new and established health care providers in a timely and complete manner.
  • Communicates with new staff in helping them to acquire their NPI, and of the sequential steps needed to begin the credentialing enrollment process, through completion.
  • Provides third-party technical support to Harbor staff providing services under contract with managed care / insurance organizations and with other units within Harbor.
  • Assists clinical staff in completing needed credentialing information.
  • Maintains credentialing information in National Database and SmartCare.
  • Works with many individuals to acquire necessary materials and information, including but not limited to : physicians, facility staff, professional staff, physician’s office staff and hospital staff.
  • Performs relevant data entry into the database to ensure consistency and integrity of the data.
  • Processes appropriate queries and assists providers in renewing expired credentials and licensure, or any appropriate regulatory credentialing requirements and maintains documentation in the database.
  • Monitors collection of all information received; follow up on missing items and / or incomplete forms, submit follow up requests for verifications as needed.
  • Ensures that all credentials are current at all times.
  • Maintains all credential files ensuring that all correspondence in the credentialing process is accurately filed; is knowledgeable and current on the process and legal / regulatory requirements.
  • Maintains clinic information and practice locations with payers.
  • Provides optimal customer service to meet the organization’s expectations.
  • Provides support to executive management in relation to credentialing.
  • Assists in maintaining payer portals, information, and billing systems.
  • Keeps current with trends and developments related to essential job competencies, and demonstrates continuous growth.
  • Performs other duties and works on special projects as requested.

    • About Harbor :

  • A leading provider of mental health and substance use treatment for over 100 years
  • 350+ clinical staff serve over 24,000 clients across multiple locations and in the community each year
  • Services ranging from counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, vocational program, and more!

    • Why Work for Harbor?

    It is fast-paced and challenging, but you will have a lot of fun in the process. You will have the opportunity to meet other motivated individuals who are also making a positive impact at our company. Harbor is committed to investing our resources in you! Some benefits of working with Harbor include :

  • Medical, dental, and vision coverage
  • Retirement plan with company match
  • Generous paid time off, sick time, and paid holidays
  • Tuition and professional license reimbursement programs
  • Clinical supervision hours offered
  • Employee referral bonuses
  • Ability to make a difference in your community!
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    Credentialing Specialist • Toledo, OH, US