General Statement of Duties:

The incumbent will be responsible for Health Plan credentialing processes. The incumbent will be responsible for developing and maintaining a systematic process for initial and ongoing credentialing requirements for direct service staff.  The incumbent will work with licensed staff, employed in a position that requires a license to complete the necessary steps to becoming a credentialed in-network provider under the HRCSB’s Tax ID # with contracted Health Plans and to maintain this status while employed in such position. The incumbent will also work closely with all direct service staff, supervisors and the HRCSB Human Resource Department to ensure staff’s  personnel records have the required supporting documentation for the level of credential needed to meet regulatory requirements as determined by the position held. The incumbent will ensure staff’s profile in the electronic health record accurately reflects the direct service staff’s Credentials and Programs Credentialed for, as determined by their position/s.

The incumbent will be responsible for tracking contracted Health Plans, staying abreast of  mergers, and obtaining and maintaining Provider Representative contact information. The incumbent will assist with payer contracting activities as determined by the Compliance Supervisor and/or Director of Administration.

The incumbent will be a knowledgeable resource to Management Team and Supervisors on Licensing Boards’ requirements as it pertains to the credentialing needs of services offered by the agency.

The incumbent will assist with data collection and outcomes activities. The incumbent will interact with directors, supervisors, clinical staff, IT, administrative staff, and at times with consumers to assist with data and outcome activities.

The position provides back up to other Compliance Department activities that includes an occasional weekend and holiday coverage for authorizations and human rights and- critical incident reporting.

The position is non-exempt under the Administrative Provision of Fair Labor Standards Act.

The agency’s Compliance Supervisor supervises this position.

Distinguishing Features of Work:

The incumbent performs under minimal day-to day supervision a range of technical responsibilities requiring independent judgment, the exercise of a high level of discretion and the use and application of quality improvement and information system techniques. The incumbent will possess the ability to comprehend and apply regulatory and policy requirements necessary to meet credentialing standards. The incumbent must possess excellent verbal and written skills and be able to organize and prioritize time sensitive tasks.

Major Duties and Responsibilities:

Perform credentialing activities independently.

  1. Establish a systematic method for obtaining and tracking initial and ongoing in-network credentialed status for newly hired licensed staff or newly licensed staff in positions requiring such status;
    • Assist new and newly licensed staff to complete the processes to obtain an NPI # and CAQH registration;
    • Perform systematic reviews of staff credentials to ensure continued in-network status;
    • Establish and maintain an up to date Excel spreadsheet of Health Plans with provider relations and credentialing contact information as well as credentialing requirements.
  2. Be knowledgeable in the  Medicaid and Medicaid MCO credentialing requirements for physician-directed clinical services and SPO services;
  3. Provide technical support to clinical supervisors and the Human Resources department on education and experience requirements as well as supporting documentation requirements for personnel records;
  4. Work with HR to ensure staff credentials and payers credentialed are accurate and up to date;
  5. Provide Administrative supports related to data collection and outcome activities;
  6. Provide Administrative Supports related to Health Plan contracting activities;
  7. Effective use of available technology, including computers, e-mail, and voice mail in order to enhance customer service;
  8. Maintain effective relationships with co-workers and community contacts based on courtesy, compassion, and respect;

Perform duties in accordance with CSB policies and procedures, and perform other duties as assigned.

Required Knowledge, Skills and Abilities:

Knowledge of Licensing Board requirements for positions requiring a license. Knowledge of licensing and credential requirements by health plans for direct service staff as determined by their position and program. Knowledge and skills in working with health plan credentialing processes. Ability to understand and assess health plan contracts, mergers and credentialing requirements.

Knowledge and experience with Excel spreadsheet development,  managing data and producing outcome reports.

Minimum Education and Experience:

Graduation from an accredited college or university with a bachelor degree in human services, business, public administration or a related area; two years experience working with behavioral healthcare, or, any equivalent combination of experience and training which provides the required knowledge, skills and abilities.

Other Information:

Equipment: Telephone, computer, fax, copier.

Work Environment: Behavioral healthcare setting with routine office lighting levels, temperature ranges, air quality, ventilation, and noise levels.

Work Location: 1241 North Main Street, Harrisonburg, Virginia

Work Hazards: Minimal hazards associated with general day-to-day behavioral healthcare operations; occasional hazards associated with problem behaviors.

Work Schedule: Full-time, Monday through Friday, regular office hours. Schedule is set and may be adjusted by the Compliance Supervisor in consideration of factors that will maximize the effectiveness of this position. If scheduled, some evening, weekend, or additional hours may be required on occasion to perform job requirements.