Credentialing Specialist

Date Posted: 9/16/2021

Location: Fort Walton Beach

 

POSITION SUMMARY:   Bridgeway Center, Inc. (BCI) is seeking applicants for the Credentialing Specialist position. Must have the ability to multi-task and remain professional at all times.

Join a dynamic and innovative team who search for empowering ways to improve the quality of life for the people we serve. A career with BCI as a Credentialing Specialist is rewarding and fulfilling because you make a difference every day in the lives of the clients served.
The Credentialing Specialist is responsible for acquiring and maintaining enrollment for federal and state contracts as well as enrolling and maintaining Medicaid, Medicare, Tricare, and third-party payor credentialing for all licensed personnel.  This position maintains all BCI records, in-house and secure online provider profiles. Accurate and timely dissemination of information about credentialing status of licensed providers is required to BCI leadership and front desk/scheduling personnel. The ability to develop and maintain positive relationships and contacts with provider relations personnel with partner agencies and pay sources is a valuable asset. The Authorization part of the job description involves obtaining authorization for services to ensure that payment is received for services. An eye for detail and willingness to follow the complexities of a constantly fluid insurance picture, especially related to Florida Medicaid Managed Care is essential. The Credentialing Specialist, like other colleagues in the department is responsible for specific insurance plans assigned by the department head and monitors Accounts Receivable, researches and corrects unpaid claims, submits appeals and makes all reasonable efforts to recover revenue. The Credentialing Specialist must have the ability to work cooperatively as a member of the team in order to ensure the smooth operation of the department.

New associates receive training, mentoring, and coaching throughout the on-boarding process.

We invite you to further explore this amazing opportunity by submitting your application today.

BENEFITS OFFERED:

  1. Ten (10) Paid Holidays
  2. 17 days per year of PTO
  3. 403(b) Retirement Plan with Employer Match
  4. Employee Assistance Program (EAP)
  5. Health Care /Dependent Care Reimbursement Program  
  6. Employer Paid $10,000.00 Life Insurance
  7. Florida Blue Group Health Insurance
  8. Vision/Dental Insurance

MINIMUM REQUIREMENTS:    A High School Diploma or GED plus six (6) years related experience. Bilingual (Spanish & English) Applicants preferred. Applicant must be able to pass a DCF Level II background screening, a drug screening, and a Tuberculosis (TB) test.  

JOB REQUIREMENTS:   We are looking for highly motivated applicants. We are excited to meet interested potential teammates. Excellent customer service skills are a must. BCI offers competitive wages and benefits to include paid holidays, Paid Time Off (PTO), health, dental, and vision insurance. Some of the job tasks and responsibilities include, but are not limited to:

  1. Responsible for credentialing all new licensed associates with current guarantors to include gathering all necessary information and applying for and maintaining NPI and CAQH enrollment. In addition, responsible for Medicaid and Medicare, Tricare, and associated 3rd party payor plans enrollment and maintenance.
  2. Responsible for credentialing/recredentialing all Bridgeway Center facilities in accordance with payor requirements, to include Medicaid, Medicare, Tricare, and additional 3rd party payors as applicable.
  3. Responsible for maintaining credentialing status of all current licensed associates.
  4. Maintain all spreadsheets and rosters as required including credentialing roster for BCI staff.
  5. Sends out a monthly report of the staff credentialed and which guarantors they are credentialed for. 
  6. Works with colleagues to ensure authorizations are acquired for any guarantors needing prior authorization.
  7. Inform Case Management and Wellness Center when clients need authorizations.
  8. Assist clinical staff in completing authorization requests for PSR and Case Management clients and ensure requests are submitted appropriately. Follow up to check on approvals.
  9. Research denied TCM and PSR authorizations for possible resubmission. Assist colleagues in researching all other authorization denials as appropriate.
  10. Assist colleagues in submitting retroactive authorization requests when possible.
  11. Assist in transmitting 3rd party claims as applicable, including resolving pre-billing edit errors and working denials for claim resubmission.

Monitor and address outstanding AR and related issues as assigned by supervisor

WORK SCHEDULE:   Monday – Friday / 8:00 a.m. – 5:00 p.m.

WORK LOCATION:    Fort Walton Beach (FWB)

BASE WAGE:   The base wage for this position is $15.00 - $18.00 per hour.

 

Click here to apply for this position electronically

 

***Applicant must meet the minimum requirements to be considered for this position. NO EXCEPTIONS.***

Notify the Human Resources Office in advance if you require special disability accommodations to participate in the employment process.

BRIDGEWAY CENTER, INC. IS A DRUG FREE WORKPLACE AND AN EQUAL OPPORTUNITY EMPLOYER

Hours: Full-Time