Credentialing Specialist jobs in Raleigh, NC

Job Definition:

• Credentialing of New Hire Clinicians
• On Board New Hires
• Audit HR Charts
• Audit Medical Records
• Analyze Data Metrics
• Manage CARF Accreditation
• Measure Performance Metrics
• Manage Database
• Conduct Staff/Client Survey

• Medicare & Medicaid revalidations
• Recredentialing for all payers
• Update and assist with CAQH practice and clinician profiles
• Update licensure and certificates of insurance to payers
• Completion of data validation from payers
• Manage roster submission, review, and data entry
• Resolve enrollment related denials

• Create reporting process, On-board New Hires and maintain HR records, organize Medical Records and update all Credentialing applications for all Staff while linking to the appropriate insurance companies.

Perform quarterly HR audits.
Maintain HR database

*Responsible for Quality Assurance and auditing of medical record information
Assist with Medical Billing for Medicaid and Private Insurances
Prepare monthly report of expenses and revenues for CEO
Answer phones, type letters, memorandum, reports, etc.
Maintsin quarterly Audit reporting

Billing & Insurance experience preferred!

Mental Health experience a plus

Job Type: Full-time

Required Qualifications and Experience:

• Qualified Professional experience a plus
• Bachelor's Degree

• Be familiar with Substance Abuse Services and Mental Health environment
• Familiar with Credentialing requirements for Commercial, Private Pay Medicare, and Medicaid Insurance
• Preferred Qualifications and Experience:

• Familiarity with Alliance and VAYA Managed Care Organizations

• Benefit Conditions: Only full-time employees eligibleCOVID-19 Precaution(s): Remote interview process

• * Personal protective equipment provided or required

*

• Plastic shield at work stations
• Temperature screenings
• Social distancing guidelines in place
• Virtual meetings
• Sanitizing, disinfecting, or cleaning procedures in place

Typical end time:

• 5PM

Typical start time:

• 9AM

This Job Is:

• A “Fair Chance” job (you or the employer follow Fair Chance hiring practices when performing background checks

Job Type: Contract

Pay: $20.00 - $25.00 per hour

Expected hours: 10 per week

Benefits:

• Paid time off

Medical specialties:

• Primary Care

Schedule:

• 4 hour shift
• Monday to Friday

Education:

• Associate (Preferred)

Experience:

• ICD-10: 1 year (Preferred)
• Medical Billing: 1 year (Preferred)

Work Location: In person