Credentialing Specialist

Location: Portland, OR (with some remote flexibility)
Supervisor: Practice Manager
Employee Classification: Non-Exempt (Hourly), Full-Time
Hours: Full-Time, 40 hours per week
Compensation: $26.00/hour

Primary Function:

The Credentialing Specialist coordinates and performs all credentialing functions, including coordinating with appropriate insurance plans, submitting & re-submitting provider applications, and manages compliance requirements as outlined below. The Credentialing Specialist works independently with minimal supervision.

Essential Functions:

• Manages the PMHW credentialing process for all clinical providers in accordance with accreditation standards.
• Manages the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems.
• Coordinates the management of the electronic credentials application, to ensure distribution, receipt, processing, and timely delivery to health system entities.
• Coordinates the management of the “expiration process” to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
• Monitors and reports turnaround times for processing of credentials applications, with continued focus on delivery of a high quality product, with the greatest efficiency, in the least amount of time.
• Prepares for and coordinates credentialing audits in compliance with the credentialing contracts.
• Functions as primary PMHW credentials contact for all internal and external inquiries; develops and maintains positive working relationships with insurance partners.
• Additional tasks or duties as directed or assigned.
• Additional Regulatory & Compliance Responsibilities as Assigned

Performance Requirements: 

Knowledge: 

• Knowledge of or willingness to learn the practice’s policies and procedures. 
• Knowledge of or willingness to learn industry specific terminology and insurance practices, as well as the nuance of credentialing.
• Knowledge of grammar, spelling, and punctuation, for effective and appropriate communication.
• Knowledge of web-based computer programs and applications in an Apple/Mac environment

Skills: 

• Use office equipment, and handle and file paperwork adequately.
• Handle incoming phone calls and respond or resource appropriately. 
• Communicate effectively, both verbally and in writing. 
• Gather, interpret, and report insurance information. 
• Navigate patient privacy with critical thinking and follow through.

Abilities: 

• Ability to work effectively as a team member, and to communicate clearly, compassionately, and respectfully, with medical and mental health professionals, as well as with administrative support staff.
• Ability to interpret and understand insurance benefits.
• Ability to flexibly respond to changing demands within the work environment. 
• Ability to organize and prioritize tasks, time, and responsibilities effectively, as well as to work independently and with minimal supervision.
• Ability to establish and maintain effective working relationships with patients, employees, and the public. 
• Ability to function proficiently in a web-based computer environment.
• Work with Mac OS & GSuite

Minimum Qualifications:

• Demonstrate competence and humility in terms of race, ethnicity, gender, sexual orientation, religion, class, ability et al
• Demonstrate commitment to the preservation of a workplace which embraces diversity
• Demonstrate a strong understanding of individual privacy, understanding that they are handling highly sensitive and personal/confidential information of PMHW employees, particularly clinicians/providers.
• Demonstrate a strong understanding of all compliance requirements
• Show compassion: Employees may see people during moments of trauma or crisis, where they and their family are vulnerable or in pain
• Work well independently
• Communicate professionally and effectively with patients and clinicians, always providing stellar customer service
• Answer electronic phone systems with excellent etiquette – a warm/friendly tone, articulate, and providing intelligible responses to questions or concerns
• Demonstrate a strong understanding of HIPAA policies and regulations
• Demonstrate a strong attention to detail and organization
• Demonstrate patience: being patient with people who may have trouble communicating or understanding what is happening is imperative for this position
• Follow policies and procedures to contribute to the administrative efficiency of the practice, taking initiative to suggest and develop those that may be needed
• Demonstrate strong computer skills including web based systems
• Ability to work with Mac OS & Google Workspace

Equipment Operated: Standard office equipment, including computers, copiers, printers, telephones, etc. 

Work Environment: When working from a PMHW office, the position is in a well-lit office environment. Varied activities including sitting, standing, walking, reaching, bending, and lifting. 

Mental and Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder. Ability to tolerate mental and emotional distress as an anticipated aspect of the position. May require working under stressful conditions.

Portland Mental Health & Wellness offers a competitive benefits package for full time employees that includes:

• Paid Time Off (80 hours per year, to start)
• Paid Health Leave (40 hours per year)
• Paid Floating Holiday Hours (80 hours per year)
• Medical and Vision Insurance – Kaiser (choice of three plans) – Covered at 70%
• Dental Insurance – Principal – Covered at 70%
• Employer Paid Life and AD&D Insurance – Principal
• Voluntary Additional Life and AD&D Insurance – Principal  
• Voluntary Short Term Disability Insurance – Principal 
• Voluntary Critical Illness Insurance – Principal 
• Voluntary Accident Insurance – Principal 
• Flexible Spending Account, Health Care – Ameriflex
• Flexible Spending Account, Dependent Care – Ameriflex 
• Commuter Benefits – Choice of One Below:
  • Monthly TriMet Transportation Pass – Covered at 100%
  • Parking Reimbursement – Up to $100 per month
• 401K Retirement Plan – Up to 4% Company Match Once Eligible
• Quarterly Profit-Sharing Incentive
• Annual Administrative Continuing Education Allowance
• Discounted Enrollment with Student Loan Tutor
• 20% Discount on Vitamins & Supplements Through Fullscript
• Discounted Monthly Membership with Müv Fitness
• Limited Access to Columbia Sportswear Employee Store
• 15% Discount at VioletSuitesPDX
• OnPoint Community Credit Union Group Banking Benefits

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This description is intended to provide only the basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as the practice’s needs evolve. Regular and predictable attendance is an essential function of every job.

The requirements described above are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. By signing below, you acknowledge that you are able to perform the Essential Functions of this job, with or without accommodation. If an accommodation is needed, you acknowledge that you have an opportunity to discuss this with Human Resources.