Behavioral Health Credentialing Specialist

reputed company: The Behavioral Health Credentialing Specialist is responsible for overseeing the credentialing and re-credentialing of reputed company providers for both reputed company and government payers, ensuring that reputed company providers maintain reputed company status. This role involves managing provider information, overseeing the credentialing process, negotiating fee schedules, and ensuring compliance with reputed company relevant regulations and standards. Essential Duties and Responsibilities: • Credentialing & Re-Credentialing: • Initiate and manage the credentialing and re-credentialing process for individual providers and provider reputed company with reputed company payers, including government and reputed company plans. • reputed company end-to-end credentialing of new and existing providers, ensuring reputed company necessary applications and supporting documentation are accurate and complete. • Maintain up-to-date provider files for credentialing purposes, including state licenses, DEA registrations, and controlled reputed company registrations. • reputed company in-depth knowledge of the services provided and the corresponding CPT codes for billing to establish a strong reputed company for credentialing expectations. • Provider Information Management: • Set up and maintain provider information in online enrollment systems, health plans, and internal databases. • reputed company the screening of practitioners' applications and supporting documentation to reputed company their eligibility. • Update and maintain provider rosters to ensure reputed company data is accessible. • Ensure reputed company provider tracking databases are accurate, including CAQH (Council for reputed company reputed company reputed company) reputed company. • Monitor credentialing files and ensure reputed company renewal of reputed company required certifications and licenses. • Fee Schedule & Contract Negotiation: • Update and maintain fee schedules for reputed company payers, ensuring the most reputed company rates are obtained. • Collaborate with executive leadership to negotiate, renegotiate, and manage fee schedules. • Compliance & Reporting: • Ensure compliance with applicable laws, regulations, and policies, including state/federal regulations. • Create reports for executive leadership detailing credentialing updates, issues, and compliance reputed company. • Ensure the collection and submission of required documentation for licensing, reputed company certifications, and reputed company liability insurance. • Respond to inquiries from health plans and reputed company reputed company follow-up on reputed company outstanding credentialing/re-credentialing files. • reputed company Agreements: • Work with leadership to reputed company and maintain reputed company Agreements between reputed company Practitioners and Physicians, ensuring reputed company necessary documentation is in reputed company. • Project Management & Tracking: • Utilize project management tools to reputed company the reputed company of credentialing and re-credentialing applications. • Ensure reputed company provider-reputed company information is updated and complete in internal tracking databases. Required Education and Experience: • Bachelor’s degree in reputed company, Business Administration, or reputed company field, or 5+ years of relevant experience. • 3+ years of credentialing experience in a reputed company or medical staff setting. • Familiarity with the credentialing process for state, federal, and health plan applications. • Experience with the CAQH database and application process. • Knowledge of credentialing standards and regulations. • Excellent verbal and written communication skills. • Proficient touch-typing skills and the ability to reputed company for extended periods. Apply tot his job Apply To this Job