Are you doing what you love? We are!

Employees of Pacific Neuropsychiatric Specialists (“PNS”), are important members of a team effort. We hope that employees will find their position with PNS rewarding, challenging, and productive. Our employees have been the fuel of our successful growth and are the foundation of our future. We support healthy work/life balance for our employees and invest in their potential through opportunities for continual learning and growth.

If this resonates with you, then read on!

We are seeking a motivated and like-minded Credentialing Coordinator with clear goals of advancing our culture in the fast-paced and exciting field of mental health! This is a full time in office position. The Credentialing Coordinator is primarily responsible for coordinating, managing, and maintaining Credentialing services for Providers/Practices, as well as establishing and maintaining Credentialing relationships with Payers/Networks. The Credentialing Specialist will assist Providers/Practices in the various aspects of preparing, processing, submitting, and monitoring both paper and electronic forms and documents; including managing and storing of all pertinent data and documentation for Credentialing/Re-Credentialing purposes. They will coordinate and communicate with Providers and Payers to ensure that all Credentialing requirements are fulfilled. They will monitor accounts and manage the Credentialing process from start to finish. They will be technical, organized, intuitive, and creative. They will be willing to develop new skills and learn quickly. They will prove their desire to be an innovative and self-reliant team member that is flexible and not afraid of changes and new developments within the department.

Required Skills and Qualifications:

Communication skills: Due to the nature of behavioral health, communication must be professional, clear, calm, and sensitive at all times regardless of the circumstances.

Phone and computer literacy: Must maintain phone and computer handling skills.

Other skills: a background in credentialing (required) and email/phone etiquette

Ability to analyze complex application problems and provide solutions

Ability to work with multiple projects and deadlines

Knowledgeable of current accreditation standards

Detail oriented and possess strong organizational skills in a fast-pace environment

Education and Experience

High School Diploma required, BA/BS Degree preferred

5 years’ experience with healthcare credentialing required

CPCS certification preferred

General Duties:

Obtain all credentialing documents and logins from providers in a timely manner.

Complete health plan enrollment/credentialing applications for all licensed providers with all Medicare, Medicaid and commercial health plans

Complete credentialing applications for facilities for all licensed providers

Use credentialing tracking tools to maintain accurate record of progress with health plans and to update provider and facility health plan identification numbers and other required database fields.

Manage communication regarding the timeliness of returned forms from providers.

Track providers expirables

Re-attest and upload documents in provider CAQH profile

Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, contract standards and guidelines, etc.

Verifies provider documents and ensures that they meet contract requirements and maintain documents in an electronic filing system

Coordinate and maintain the Credentialing management database. Update Payer Manager and Credentialing application.

Monitor all documents and data exchanged within the Credentialing database in order to ensure quality of services, and accurate completion of Credentialing forms and processes.

Coordinate with Providers to ensure that proper enrollment ensues based on individual Payer requirements.

Maintain Payer Credentialing forms. Conduct periodic audits of all forms and related cover sheets for accuracy and changes, as well as Payer process flow.

Help to develop and design innovative tools, features, and work flows to improve Credentialing

Organize, label and file Credentialing forms, applications and documents.

Manually prepare, review, complete, and sign forms and documents when needed. Document all Credentialing packages prior to transmitting them to Payer. Coordinate with the Payer to ensure that all Credentialing requirements are met.

Train clients (Providers/Office Staff) how to use all features of the Credentialing application services

Submit Credentialing forms and applications to Payers as needed. Follow-up on pending applications with Payers and transmit external notices to Providers via phone, email or account messages

Complies with all Federal, State, accreditation and institutional policies and procedures.

Use minimum data necessary to identify transactions. Claim ID, Claim File Upload ID, ERA Trace Number/Check ID. Only when those identities are not enough for the recipient to find the transaction, then use the minimum PHI needed to identify the transaction.

Ability to audit, review documents for accuracy and data to meet payer requirements

Establish records and reports of all data and documents on behalf of Practice/Client

Coordinate and monitor management of Credentialing data and documents.

Ability to exercise a high level of tact and discretion in both internal and external interactions

Ability to create and maintain good working relationships with a variety of internal and external constituents.

Data Entry of Provider Information such as NPI, and Licensing Information

Other duties as assigned

Compensation and Benefits:

PNS offers a competitive compensation package including; medical, dental, and paid time off for full time employees.

Hourly rate based on skill, experience and tenure of your profession.