Credentialing Specialist

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our mission - and our passion - is to improve the lives of the members we serve and be the ideal partner for our providers.

Lucet's unique combination of people and technology has proven to optimize access to behavioral health care providers and increase a health plan's ability to connect members to quality care. With the industry's largest network of care navigators and technology powered by more than six million assessments and more than 20 years of data, Lucet is the only solution proven to successfully identify and connect people across the entire acuity spectrum with the right care in less than five days on average, and often as little as one day.

Our members, providers and partners fully entrust us to deliver outstanding quality care through coordinated behavioral health services, employee assistance programs, organizational consulting, student well-being programs and more.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Job Summary

The Credentialing Specialist facilitates the process of credentialing and recredentialing of providers (clinicians and facilities). In addition to supporting provider credentialing, the Specialist will support guiding a team of Credentialing Coordinators in their decision making to ensure adherence to credentialing standards and turnaround times.

Essential Functions

• Credential and re-credential behavioral health providers (clinicians and facilities).
• Maintain high-level of quality in credentialing files (90% or above).
• Utilize and update credentialing systems and electronic files.
• Review Credentialing Coordinators' files for accuracy and completion.
• Understand and adhere to current NCQA Standards, and its subsequent updates, and Lucet policies and procedures pertaining to credentialing- including customer contract provisions surrounding credentialing.
• Work closely with Network Operations' management team.
• Mentor and training Credentialing Coordinators.
• Serves as a credentialing and process subject matter expert.
• Conduct ongoing licensure/Medicare/Medicaid sanctions/Medicare Opt Out monitoring.
• Support the Credentialing Committee meeting, including Clean file Committee process.
• Run reports and analytics of credentialing data, as may be requested.
• Other duties as assigned.
• Adheres to Lucet Mission Statement, Core Values, Code of Business Conduct and Compliance Program
• Complies with all Federal and applicable State laws and Lucet policies regarding privacy, confidentiality and security of health information and other designated information
• Coordinate efforts of team to address Provider Relations issues as needed
• Run Credentials Committee in the absence of the Credentialing Manager
• Respond to department needs as necessary

Job Qualifications

Required

• Highschool diploma and 5 years of health-related experience OR Associates degree and 3 years of health related experience or Bachelor's degree and 2 years of health related experience
• 2 or more years of previous credentialing experience
• Exceptional customer service skills
• Excellent verbal, written, and oral communication skills
• Ability to troubleshoot issues and problem solve
• Strong computer skills
• Proficient in Microsoft Suite

Preferred

• Bachelor's degree in a healthcare related major
• 5 or more years of previous credentialing experience including delegated credentialing.
• Experience with credentialing file and program audits.

Key Competencies

• Detail-oriented and conscientious
• Works well with others
• Responsible and dependable
• Problem-solver
• Excellent communication skills
• Excellent organizational skills

Working Conditions

• Work is performed indoors in a remote, home setting or typical office environment - not substantially exposed to adverse environmental conditions.
• Frequent exposure to VDT screens, video calling, headphones, and computers.
• Physical demands include constant ability to remain in a stationary position, move about inside an office or remote setting, able to communicate and exchange information with others, able to inspect information, and able to perform repetitive motion with arms and fingers.
• Mental demands include constant ability to interpret data, problem solve, make decisions, and organize and plan.

Salary and Other Compensation:

The starting salary that Lucet reasonably expects to pay for this position ranges from $43,000 - $60,000 annually, depending on circumstances including an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.

This position is eligible for a bonus in accordance with the terms of Lucet's incentive plan based on both company performance and individual performance. 

Benefits: The Company offers the following benefits for this position, subject to applicable eligibility requirements: Medical, Dental, Vision, 401(k) with competitive employer match, company paid life and disability insurance, company paid gym access, tuition reimbursement, parental leave, PTO (vacation, sick and volunteering), Remote Work.

Salary : $43,000 - $60,000