Credentialing Support Specialist | PAM Health Corporate

About the role

The Credentialing Support Specialist supports the completion of Credentialing and Re-credentialing material submitted to Managed Care Organizations and provides them evidence of fully qualified facilities in PAM Health's Rehabilitation Hospitals, Long Term Acute Hospitals and Psychiatric Hospitals. This position gathers and communicates data progress regularly to ensure operational readiness and network participation for PAM Health facilities, provides administrative support and project work to the Managed Care Department as needed, supports approximately 72 Post Acute centers in 18 states, and reports to the Administrator Managed Care Credentialing.

Responsibilities

• Complete credentialing and re-credentialing applications (specifically tracking and initiating renewals at least 60 days prior to expiration)
• Maintain robust records of credentialing communications, submissions and approvals
• Proactively communicate with payors to ensure end-to-end credentialing cycles
• Verify/Audit provider directory information within payor databases
• Audit internal credentialing databases
• Coordinate urgently when facilities present overdue credentialing in completing re-credentialing requirements (failure to recredential can be grounds for health plan contract termination)
• Support external and internal communications efforts that help accelerate the credentialing process
• Prepare rosters for submission to payors
• Coordinate with Administrator Managed Care Credentialing to collect, verify, and organize necessary documentation for applications
• Troubleshoot and resolve issues that may hinder timely participation with plans
• Support efforts to understand recredentialing 3-year time frames and anticipate the need for timely recredentialing before Health Plans initiate it
• Perform other duties that support the Managed Care Department as assigned

Customer Service Expectations

• Maintain the highest level of customer service via courtesy, compassion and positive communication
• Support the Managed Care Team and PAM Health Facilities in a timely fashion with respect to all aspects of credentialing support and follow-up
• Promote the mission and vision of PAM Health within the work environment and the community
• Understand that Credentialing is the initial step required before moving forward with Health plan agreements
• Respect dignity and confidentiality by adherence to all applicable policies and procedures

Health and Safety

• Work in a manner that promotes safety; wear clothing appropriate to the performance of the job
• Participate in OSHA required training
• Follow universal precautions as appropriate for position; comply with Employee Health requirements for continued employment
• Report unsafe practices to management
• Know own role in case of an emergency

Qualifications

Education: Associates Degree in Health or Business Administration preferred. High School diploma or GED with two (2) or more years of relevant work history will be considered. PESC certificate through applicable organization is a plus.

Experience: Two (2) or more years of experience in healthcare enrollment, credentialing, or medical practice operations. Experience in a role requiring high-volume data collection and stakeholder communication.

Required Skills

• Proven track record of managing data with sharp attention to detail (absolutely necessary and critical for success in this role)
• Strong proficiency with computer skills including MS 365 applications (Excel, Word, Outlook, PowerPoint) and PDF editing
• Ability to multitask (this position covers multiple markets and facilities)
• Critical thinking to analyze a project/problem and work through it effectively
• Ability to manage time and prioritization of work/projects
• Demonstrated professionalism and exceptional interpersonal, written and verbal communications skills
• Basic familiarity with Insurance Plans and Medical Databases
• Ability to adhere to strict confidentiality guidelines and operate with the utmost integrity and discretion
• Teamwork
• Able to follow through with delegated tasks and accountability
• Learning focused
• Dedicated to results and thorough follow up
• Knowledge of commonly used credentialing concepts, practices and procedures (Primary Source Verifications, Designated Equivalency Sources, Malpractice History, etc.)
• Demonstrated ability to function independently with minimal direct supervision

Healthcare facility enrollment experience preferred.