Finance Assistant - Credentialing/Contract Specialist Job #43 

Full time opening in Treatment Services - OTP.

Purpose:

Responsible for all aspects of the contracting, credentialing, and re-credentialing process for all providers who provide patient care at Spokane Regional Health District Treatment Services. Responsible for ensuring providers are credentialed, appointed and privileged with health plans. Maintain and monitor up-to-date data for each provider in the credentialing process and online systems; ensure timely renewal of licenses and certifications. Maintain records of verification and current contracts, including credentialing/re-credentialing files. Assists in the contracting process by maintaining contact with the health plans and ensuring the flow of the contracts follow a checklist process. The position will develop and maintain a working knowledge of the statutes and laws relating to credentialing. Understands and has some knowledge regarding negotiating and in-network contracts with multiple insurance plans and government agencies. Understands the importance of timely re-credentialing and contracting to facilitate the billing functions to provide cash flow to the program. This role will also provide internal billing functions for the program.

• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current licenses, DEA certificates, malpractice coverage and any other required credentialing documents.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Set up and maintain files for provider information and on-line credentialing databases and systems.
• Tracks licenses and certification expirations for all providers to ensure timely renewals.
• Establishes and maintains provider National Provider Identification (NPI) registration and NPPES information database.
• Ensures program information is current with all health plans, agencies and other entities.
• Processes applications for appointment and reappointment of privileges.
• Audits health plan directories for current and accurate provider information.
• Upon termination of existing providers review and ensure that process is followed through with the health plans and/or any applicable contracts.
• Performs monthly debarment lookups on providers.
• Responds to inquiries from internal and external customers on day-to-day credentialing issues.
• Maintains program provider, health plan and contract files.
• Follows up for return of signed contracts, amendments and/or credentialing applications.
• Reviews contracts for general language such as filing timeliness, clean claims, length of terms, rates, etc. and provides any questionable language to Program Manager for review.
• Identifies issues that require additional investigation, evaluation and/or validates discrepancies and facilitates appropriate follow-up of contracts.
• Processes agreements/contracts with external parties to assure review, signature, and completion.
• Obtains required signatures for contracts and follows process of completion.
• Assists with financial and program audits related to contract documentation and correspondence.
• Performs daily routine eligibility lookups.
• Generates files for billing and eligibility reviews.
• Investigates claims’ payment issues.
• Monitors system for outstanding claim issues and to ensure that we are getting paid according to contract terms.
• Assists in maintaining and updating client payment/billing information in MyEvolv.

Minimum Qualifications:

Associate's Degree in business or closely related field required. Bachelor's degree preferred.
Three to five years advanced administrative experience, including two years related contract/credentialing experience.

Knowledge, Skills and Abilities:

• Ability to proofread documents in critical detail.
• Ability to prioritize multiple tasks while meeting critical deadlines.
• Ability to maintain good working relationships with outside agencies, i.e. health plans, co-workers and community partners.
• Ability to maintain knowledge of utilizing a multitude of various and different programs required by different agencies.
• Knowledge of Microsoft Office or similar programs.
• Strong ability to learn, understand and use Spokane Regional Health District computer programs.
• Skills in organizing, prioritizing and handling multiple tasks simultaneously.
• Organize and present information and ideas clearly both orally and in writing.
• Ability to perform duties with close attention to detail and high degree of accuracy.
• Ability to utilize and maintain computer spreadsheets and databases.

Equal opportunity employer.