Credentialing Specialist

Job Description

Job Description

Job Description

As a Credentialing Specialist for Little Havana Activities and Nutrition Centers you will be responsible to compile and maintain all relevant information and documentation for a provider’s file to be considered for participation within the network. This documentation includes, but is not limited to, applications, contracts, primary source verifications, insurance claims history, etc. In addition, you will be working closely with the provider, claims, provider relations, and case management department to ensure timely and appropriate follow up.

Duties and Responsibilities:

• This role is primarily an in-office position but will need to travel on the road to meet with clients.
• Initiates, maintains and verifies all aspects of the credentialing and re-credentialing applications and process for providers.
• Completes and reviews all applications to ensure accuracy and completeness prior to submission.
• Manages a provider case load of approximately 200-300 providers.
• Acts as a subject matter expert in determining provider terminations, encounter submissions, claims portal access/training, authorization process, reports handler, payment processing, inquiry submissions, etc.
• Coordinates appointments with providers in a time efficient manner—coordinating travel time in addition to handling situations as they arise. Time sensitive reporting with same day turnaround time often required.
• Handles a high volume of daily phone calls.
• Adheres to program expectations through attention to detail and highly organized approach to ensure compliance with approval or denial timelines.
• Facilitates provider trainings as necessary—trainings can include as many as 120 providers at one time; secures training locations and all necessary logistics.
• Identifies “red flags” and addresses them accordingly in relation to provider’s ability to render services.

JOB SPECIFICATIONS/QUALIFICATIONS

• Bachelor’s Degree in Health Related Field and one (1) year of Credentialing or Provider Data experience; OR High School Diploma / GED Equivalent with minimum of two (2) years of experience in Credentialing or Provider Data experience. Fully bilingual English/Spanish to provide services to a predominantly Hispanic, elderly client base.

PREFERRED EXPERIENCE AND ATTRIBUTES

· Experience and knowledge of Long Term Care (LTC) and/or Managed Care Organization (MCOs).

· Excellent oral and writing skills

· Strong customer service orientation with ability to educate providers, clients and staff.

· Strong computer and data entry skills; Microsoft Word, Excel, Outlook & Internet searches

· Effective and efficient organization and time management skills

· Effective analytical and problem-solving skills

· Ability to maintain strict confidentiality and handle sensitive information.

· Good telephone and other distance communications skills; flexibility in dealing with simultaneous projects, issues, and timelines.

· Ability to respond well under pressure and work in a fast-paced environment.

It is the policy of LHANC to provide equal opportunity to all applicants and to administer ongoing employment matters in a manner which does not discriminate on the basis of an individual’s race, color, creed, religion, national origin, gender, age, marital status, disability, veteran status, genetic information, or any other basis protected by applicable state, federal, or local law.

Company DescriptionCome work for Little Havana Activities and Nutrition Centers of Dade County, Inc., a non-profit organization that serves socially isolated and economically disadvantaged seniors in the South Florida area. At LHANC, we believe in serving with passion and doing the right thing. Our mission is to provide a wide-range of social services to socially isolated and economically disadvantaged seniors in the South Florida area. We identify the need and procure the funding necessary to provide low-income, frail, isolated elderly persons with quality social, nutrition, and health services allowing them to continue to live at home, albeit with some assistance and to avoid early, costlier institutionalization. Our services are all provided to aid the rapidly increasing elderly population with essential services in a loving and sensitive manner. We are a tax-exempt, charitable non-profit corporation that is funded through government grants and private donations.

The Rainbow Intergenerational Learning Center and Child Care Program provides an opportunity for children to develop their maximum potential. The service is offered to working for low-income families. By providing them with access to safe, quality child care services, children of low-income families are prepared to compete on an equal basis with other children of better economic means.
By identifying the obstacles that prevent children from learning, the program enables its children to develop the skills necessary to succeed in their school life.
In addition, parents will find a safe, professional, loving, and culturally sensitive environment for children while they become better informed on issues relative to child rearing.
Rainbow Child Care Services are offered to children between the ages of 0 through 5. This program is offered on a sliding scale fee and subsided services are also available.

Company Description

Come work for Little Havana Activities and Nutrition Centers of Dade County, Inc., a non-profit organization that serves socially isolated and economically disadvantaged seniors in the South Florida area. At LHANC, we believe in serving with passion and doing the right thing. Our mission is to provide a wide-range of social services to socially isolated and economically disadvantaged seniors in the South Florida area. We identify the need and procure the funding necessary to provide low-income, frail, isolated elderly persons with quality social, nutrition, and health services allowing them to continue to live at home, albeit with some assistance and to avoid early, costlier institutionalization. Our services are all provided to aid the rapidly increasing elderly population with essential services in a loving and sensitive manner. We are a tax-exempt, charitable non-profit corporation that is funded through government grants and private donations.\r\n\r\nThe Rainbow Intergenerational Learning Center and Child Care Program provides an opportunity for children to develop their maximum potential. The service is offered to working for low-income families. By providing them with access to safe, quality child care services, children of low-income families are prepared to compete on an equal basis with other children of better economic means.\r\nBy identifying the obstacles that prevent children from learning, the program enables its children to develop the skills necessary to succeed in their school life.\r\nIn addition, parents will find a safe, professional, loving, and culturally sensitive environment for children while they become better informed on issues relative to child rearing.\r\nRainbow Child Care Services are offered to children between the ages of 0 through 5. This program is offered on a sliding scale fee and subsided services are also available.