Credentialing and Enrollment Specialist at Youth and Family Alternatives

New Port Richey, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Aug, 26

Salary

0.0

Posted On

05 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Credentialing, Network Enrollment, HIPAA Compliance, CAQH, NPPES, Medicaid Enrollment, Commercial Insurance Enrollment, Auditing, Microsoft Office Suite, Trauma-Informed Care, Interpersonal Communication, Organizational Skills

Industry

Individual and Family Services

Description

PART-TIME POSITION Job Summary: This is an administrative position with responsibility for provider payer credentialing and network enrollment. In addition to the duties and requirements listed below, YFA expects employees to be committed to incorporating principles of trauma-informed care in all areas of service delivery. Commitment to these principles is demonstrated through active participation in agency-required training, use of trauma-informed practices, and understanding that trauma-informed environments require cultural sensitivity and an emphasis on a safe and respectful environment for all. Essential Functions: * Prepare, review and submit credentialing and enrollment applications and associated documentation in accordance with insurance plan payer network enrollment and renewal requirements. * Track, monitor, and maintain credentialing and recredentialing deadlines for providers, programs, and locations for the organization to ensure continuous plan participation and compliance. * Communicate proactively with providers, payers, and internal teams regarding credentialing status, updates, and delays. * Confirm licenses, education, training, and certifications of behavioral health and healthcare providers. * Update internal and external credentialing databases to reflect current status and upcoming renewals, including but not limited to CAQH, NPPES, payer portals as applicable; conduct regular audits to ensure data accuracy. * Ensure compliance with state, federal, and accreditation standards (i.e., COA). * Maintain HIPAA compliance and confidentiality at all times. * Support billing system setup, payer portal setup, workflow development, and process improvement as the organization grows. The above duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform. Education & Experience: * High School Diploma or equivalent required. * Credentialing Specialist Certification required. * 2 years of experience with Medicaid and commercial insurance network payer enrollment, provider credentialing, and billing required. * Preferred experience using electronic billing systems, clearinghouses, payer portals, and electronic health record platforms. * Preferred knowledge and understanding of trauma-informed principles and practices, including the importance of creating a safe environment, fostering trust, promoting collaboration, and empowering individuals. Physical Requirements: Position requires employees to work with computers daily. Ability to lift 5 pounds, bend, stand or sit for extended periods of time. Knowledge, Skills & Abilities (KSAs): * Ability to communicate effectively, verbally, and in writing. * Ability to document timely in a clear, concise, accurate, and detailed manner. * Ability to audit and verify accurate documentation. * Must have strong interpersonal skills for interacting with providers and insurance plan representatives. * Must have strong organizational skills. * Ability to work independently and meet deadlines. * Abide by principles of EEO compliance and a workplace of dignity and respect. * Abide by core values and mission statement of the agency. * Proficiency in Microsoft Suites.

Responsibilities

Responsible for managing provider payer credentialing and network enrollment applications to ensure continuous plan participation. This includes tracking deadlines, verifying provider certifications, and maintaining internal and external credentialing databases.