Credentialing Support Specialist | PAM Health Corporate

Overview

The role of the Credentialing Support Specialist is to support the completion of Credentialing and Re-credentialing material submitted to Managed Care Organizations and provide them evidence of fully qualified facilities in PAM Health’s Rehabilitation Hospitals, Long Term Acute Hospitals and Psychiatric Hospitals. Gathers and communicates data progress regularly, to ensure operational readiness and network participation for PAM Health facilities. Provides administrative support and project work to the Managed Care Department as needed. This position supports approximately 72 Post Acute centers in 18 states and reports to the Administrator Managed Care Credentialing.

Responsibilities

I. Position Responsibilities

 

· Complete credentialing and re-credentialing applications (specifically tracking and initiating renewals at least 60 days prior to expiration).

· Maintain robust records of credentialing communications, submissions and approvals.

· Proactively communicate with payors to ensure end-to-end credentialing cycles.

· Verify/Audit provider directory information within payor data bases.

· Audit internal credentialing data bases.

· Coordinate urgently when facilities present over due credentialing in completing re credentialing requirements given that failure to recredential can be grounds for health plan contract termination.

· Support external and internal communications efforts that help accelerate the credentialing process.

· Prepare rosters for submission to payors.

· Coordinate with Administrator Managed Care Credentialing to collect, verify, and organize necessary documentation for applications.

· Troubleshoot and resolve issues that may hinder timely participation with plans.

· Support efforts to understand recredentialing 3 year time frames and anticipate the need for timely recredentialing before Health Plan initiate it.

· Other duties that support the Managed Care Department as assigned.

 

II. Customer Service

 

· Maintains the highest level of customer service via courtesy, compassion and positive communication.

· Support the Managed Care Team and PAM Health Facilities in a timely fashion with respect to all aspects of credentialing support and follow-up.

· Promotes the mission and vision of PAM Health within the work environment and the community.

· Understand Credentialing is the initial step required before moving forward with Health plan agreements.

· Respects dignity and confidentiality by adherence to all applicable policies and procedures.

 

III. Health and Safety

· Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.

· Participates in OSHA required training.

· Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.

· Reports unsafe practices to management.

· Knows own role in case of an emergency

Qualifications

Education and Training:

Associates Degree in Health or Business Administration preferred. High School diploma or GED with two (2) or more years of relevant work history will be considered. PESC certificate through applicable organization is a plus.

 

Experience:

Two (2) or more years of experience in healthcare enrollment, credentialing, or medical practice operations. Experience in a role requiring high-volume data collection and stakeholder communication.

 

Knowledge, Skills, and Abilities:

 

· Proven track record of managing data with sharp attention to detail is absolutely necessary and critical for success in this role.

· Strong proficiency with computer skills including MS 365 applications (Excel, Word, Outlook, PowerPoint) and PDF editing.

· Ability to multitask as this position will cover multiple markets and facilities.

· Critical thinking, to analyze a project/problem and work through it effectively.

· Ability to manage time and prioritization of work/projects.

· Demonstrated professionalism and exceptional interpersonal, written and verbal communications skills.

· Healthcare facility enrollment experience preferred.

· Basic familiarity with Insurance Plans and Medical Databases.

· Ability to adhere to strict confidentiality guidelines and operate with the utmost integrity and discretion.

· Teamwork.

· Able to follow through with delegated tasks and accountability.

· Learning focused.

· Dedicated to results and thorough follow up.

· Knowledge of commonly used credentialing concepts, practices and procedures. (Primary Source Verifications, Designated Equivalency Sourc