Credentialing Specialist

Job Number: 25-12445

Job Summary: The Credentialing Specialist performs administrative duties for the Credentialing Coordinator. Acts with minimal to no supervision. Prioritizes and performs complex functions including: application review for initial credentialing and recredentialing for internal and external providers; primary source verification and validation of documents initially and on an ongoing basis to maintain licensure, certifications, insurance and other time-related documents, and background checks, in a timely and accurate manner generating reminder notices; data entry and database management to keep provider information accurate and updated; word processing, correspondence composition and report/query writing; high quality customer service to staff, network providers, and external entities; and semi-technical and/or professionally related assignments.

Responsible for creating, tracking, maintaining and updating provider credentialing files ensuring they meet all necessary internal and regulatory standards, and maintain comprehensive records. Responsible for verifying and maintaining on-going provider licensure and other time-related documents status in CACTUS (symplr Provider) and as applicable, in myAvatar databases. Responsible for reviewing contract requests for meeting requirements and completing the process. Must perform work with attention to detail managing workload effectively in a fast-paced environment meeting required departmental, Integral Care, state and national standards and timelines. Performs all aspects of position in a professional manner with tack and discretion maintaining confidentiality of provider information

Regular, predictable attendance is an essential requirement for this position. Other duties may be assigned. May require a flexible work schedule.

Integral Care employees are to be committed to fostering an open, inclusive, and supportive environment that welcomes and embraces diversity in all forms. Integral Care defines diversity broadly to include race, ethnicity, abilities (mental/physical), gender, gender identity, immigrant status, language, religion, sexual orientation, socioeconomic status, veteran status, age, and other groups.

Integral Care employees are to strive to maintain a trauma sensitive workplace, to embrace trauma sensitive and informed practices, and to foster a supportive and welcoming environment of care.

Education:

Required:

• Graduated from an accredited college or university with a Bachelor's degree with a major specialization in Human/Behavioral/Social Services or related field.

License/Certifications:

Required:

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification or the ability to obtain it in the future.

Experience:

Preferred:

• Two years related experience in credentialing or healthcare background with knowledge of managed care and network development, provider relation activities or healthcare delivery system
• Proficient in Microsoft Office Suite, including Word, PowerPoint, and Excel.
• Experience in credentialing software and databases, especially symplr Provider (CACTUS).
• Experience with Council for Affordable Quality Healthcare (CAQH).
• Knowledge of National Commission on Quality Assurance (NCQA).
• Experience with Medicare and Medicaid and other health plan provider enrollment.

Hours: Full-Time. 

Workdays: Monday-Friday.

Workhours: 8:00am-5:00pm.

Salary: $22.14 per hour.

Why join us: Integral Care has proudly served Travis County residents for the past 50 years. As the largest provider of behavioral health services in Travis County, we are dedicated to improving the lives of adults and children living with mental illness, substance use disorder and intellectual and developmental disabilities. By joining our team, you will find rewarding work every day alongside people who have as much compassion as you. Join us and together we can help improve the quality of life for the people we serve. Imagine your career at Integral Care!

Employee Benefits:

• Medical, Dental and Vision insurance

• Generous vacation/holiday/sick leave

• Life and Short-term/Long-term Disability Insurance

• Employee Assistance Program (EAP)

• 403(b) retirement account

• Gold's gym membership discount

• Mileage reimbursement

Integral Care strives to maintain a diverse workforce. We encourage all to apply, including those who have knowledge and/or experience working with underserved populations, including Asian and Pacific Islander, Black/African American, Hispanic/Latino, and LGBTQA communities.

All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, national origin, sexual orientation, gender identity, disability, veteran status, sex or age.

For specific positions, additional compensation may be available to those who are bilingual in both English and one of the following languages: Spanish, Chinese, Vietnamese, Korean, or Burmese.(PM16)