Credentialing Specialist jobs in Baltimore, MD

Description

Maryland Wellness (formerly known as BACHS Healthcare) is seeking a detail-oriented Credentialing Specialist to join our team! As part of the Billing Department, this position’s primary focus is to maintain current and accurate credentialing records for providers. As the Credentialing Specialist, you will be responsible for maintaining and ensuring that every rendering provider is legally licensed and/or credentialed. You will monitor and maintain updated provider data in credentialing-related databases and advise staff members on renewal dates for licenses and credentials to help ensure they can continue to work legally without lapses. You must be able to work both independently and as part of a team to ensure that the services rendered will be covered by the respective payers. You will be responsible for conducting any necessary research to ensure that the rendering providers and organization are up to date on medical policy, local licensing and certification requirements.

This position is an incredible opportunity to make a difference in the lives of others! If you are passionate about creating positive change within your community by serving those in need, then we encourage you to apply and join our team.

At Maryland Wellness, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we have developed a strong organization that is capable of providing remarkable care to our clients, families, and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.

Requirements

Essential Duties & Responsibilities 

• Creates and maintain licensing, credentials and insurance records
• Monitors applications and follows-up as needed to resolve issues, discrepancies, and obtain information from providers, payors, or other contacts
• Reviews provider enrollment applications and verifies accuracy and completeness of submission
• Communicates with insurance companies to follow up on the status of applications
• Conducts research on updated state and federal regulations and policies
• Maintains current and accurate credentialing data for providers 
• Provides real time updates to leadership on credentialing statuses and/or of any arising issues
• Helps develop internal credentialing processes
• Ensures the clinics and staff members are maintaining compliance with regulatory and accrediting institutions
• Working knowledge of basic medical terminology
• Must have working knowledge of Microsoft Office (Word, Excel, Outlook, etc.), insurance portals, and credentialing-related websites (CAQH Credentialing Database, NPPES, PECOS, ePREP, Incedo, BCBS, UHC, Aetna, Availity, Novitasphere, EverNorth, MD Medicaid EVS, etc. )
• Possesses basic knowledge of insurance eligibility/benefits and authorization verification
• Demonstrates problem-solving skills
• Clear and professional written and verbal communication skills
• Respectful, courteous and professional in all forms of communication and follows the facility's service communication protocol in all interactions
• Ability to work remotely and independently in a changing environment and handle stressful situations
• Ability to commute to the office when needed
• Demonstrates great organizational skills, be attentive to details, and be able to juggle multiple tasks simultaneously, as assigned
• Must be a team player and is able to communicate effectively with team members and leadership
• Performs departmental administrative functions as required. Answers all incoming telephone calls according to departmental telephone standards
• Maintains tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems on a daily basis
• Responds to all inquiries from throughout the system and outside related to credentialing, authorization/pre-certification and eligibility/benefit inquiries.

Required Skills & Abilities: 

• Understands the nuances of different insurance types
• Proven track record for improving process efficiencies and solving problems
• Must be detail-oriented and have excellent organizational skills
• Excellent written and verbal communication skills
• Excellent analytical and problem solving skills
• Ability to multitask
• Ability to strategically, logically, and realistically analyze, evaluate and develop solutions the agency’s business needs
• Ability to effectively build relationships with individuals of all ages, ethnicity, education, and work experience
• Understands and maintains confidentiality and all regulations regarding HIPAA and 42 CFR Part 2
• Exhibits professionalism and a friendly demeanor, and is a positive representative of the company over the phone and in person
• Comfort with computers and technology, especially Excel
• Reliable, ethical, and honest work ethic
• Willingness to work as a team player

Required Experience & Education 

• Minimum of a High School Diploma or equivalent is required
• Minimum of 2 years experience in medical billing preferred
• Minimum of 2 years experience in provider credentialing preferred
• Experience in the mental or behavioral health field preferred
• CAQH Credentialing Database, NPPES, PECOS, and ePREP experience strongly preferred

Employee Benefits

At Maryland Wellness, our employees work hard to help improve the lives and well-being of people every single day. That is why we are committed to providing competitive opportunities and comprehensive benefits that support a healthy life for you and your family when you join our team. Some of these include:

• Competitive compensation rates
• Access to an Employee Assistance Program (EAP)
• Paid Time Off (PTO)*
• A comprehensive medical plan that provides options for dental, vision, and health coverage*
• Employer provided life insurance coverage*
• 401(K) and 401(K) matching*

*For our fee-for-service contractor (1099) roles: we remain committed to your health and wellness, and we work diligently to ensure that you are connected with the right tools and resources to find the best plans or packages for your individual needs.