Credentialing Specialist- Part Time

Backpack Mission

Breaking Barriers and Healing Young Minds. Backpack Healthcare provides accessible, inclusive, and comprehensive pediatric and family mental healthcare.

Job Summary

We are seeking a highly organized and detail-oriented Credentialing Specialist to oversee and manage the credentialing process for our clinical staff. The Credentialing Specialist will play a pivotal role in ensuring compliance with regulatory requirements and maintaining the highest standards of quality in our provider network. This position is part-time (20-25 hours/week) with some schedule flexibility. $25/hr!

Key Responsibilities

1. Manage the credentialing process for all clinical staff, including psychiatrists, psychologists, therapists, and other healthcare professionals.
2. Ensure timely and accurate completion of credentialing applications, re-credentialing, and privileging processes with insurance companies, government agencies, and other relevant entities.
3. Collaborate with internal stakeholders, including HR, Compliance, and Clinical Operations, to gather necessary documentation and information for credentialing purposes.
4. Conduct thorough credentialing verifications, including education, training, licensure, certifications, and professional references. Maintain process for disciplinary actions on licensure or lapses in licensure for clinicians.
5. Develop and maintain process for change of licensure from residency program to full licensure or other changes in licensure status.
6. Stay up-to-date with industry regulations, accreditation standards, and changes in credentialing requirements, and implement necessary updates to processes and procedures.
7. Maintain accurate and organized credentialing records and databases, ensuring compliance with privacy and confidentiality standards.
8. Serve as a liaison between the organization and external credentialing entities, responding to inquiries and resolving credentialing-related issues promptly. 9. Submit and maintain payor contracts for current and new contracts, working with the Chief Clinical Officer to negotiate increased rates and maintain payer relationships.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field (Master’s degree preferred).
• Minimum of 4 years of experience in healthcare credentialing, preferably in a mental health or pediatric healthcare setting.
• Strong understanding of credentialing processes, regulations, and standards, including knowledge of NCQA, URAC, and other accrediting bodies.
• Strong understanding of credentialing platforms including CAQH.
• Excellent organizational skills with a keen attention to detail and accuracy.
• Proficiency in using credentialing software and databases.
• Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal teams and external stakeholders.
• Certification in Medical Staff Services (CMSS) or Certified Provider Credentialing Specialist (CPCS) is a plus.

Backpack Healthcare is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team.