Credentialing Specialist at Wingspan Care Group – Shaker Heights, Ohio

Benefits:

At Wingspan, we prioritize our employees and their wellbeing. We provide competitive benefit options to our employees and their families, including domestic partners and pets.

Our offerings include:

• Comprehensive health and Rx plans, including a zero-cost option.
• Wellness program including free preventative care
• Generous paid time off and holidays
• 50% tuition reduction at Case Western Reserve University for the MSW program
• Defined benefit pension plan
• 403(b) retirement plan
• Pet insurance
• Employer paid life insurance and long-term disability
• Employee Assistance Program
• Support for continuing education and credential renewal
• Ancillary benefits including: dental, vision, voluntary life, short term disability, hospital indemnity, accident, critical illness
• Flexible Spending Account for Health and Dependent Care

Qualifications:

• Education: Bachelor’s Degree preferred. Minimum of High School Diploma with a minimum of 5 years of relevant experience will suffice.
• Skills/Competencies:
  • Sensitivity in relating to persons of varying backgrounds and demonstrate ability to work with diverse groups of people possessing various strengths, aptitudes and abilities.
  • Ability to perform job responsibilities with a high degree of initiative and independent judgment.
  • Demonstrated oral and written communication skills and effective interpersonal skills.
  • Proficiency in using Agency computer systems and software as required to perform essential job functions
  • Practical and creative problem solving skills.
• Minimum 3 years administrative experience in an office environment required.
• Minimum 1 year Behavioral Health experience required.
• Minimum 1 year credentialing experience preferred.

Agency Summary:

Wingspan Care Group is a nonprofit administrative and management organization that provides a united, community-based network of services so member agencies can focus on mission-related goals. Our innovative model is designed to promote sustainability and advancement among its partner agencies by streamlining operations and eliminating redundancies – resulting in improvements to the delivery of direct service operations.

Position Summary:

The Credentialing Specialist is responsible for assisting providers with maintaining an active status by completing initial and subsequent credentialing activities as required by federal, state and local regulations, contractual obligations and payer credentialing requirements.

Responsibilities Include:

• Maintain accurate and up-to-date credentialing records for Agency employees, including meeting with Agency staff at their respective locations to ensure a smooth credentialing process.
• Monitor license and credential expiration dates and advise staff members of required licensure “renew by” dates.
• Provide direct credentialing support to staff through activities including, but not limited, to assisting staff in obtaining their OH-ID, obtaining and updating their National Provider Identifier (NPI), applying for and maintaining their status as an Ohio Medicaid Provider utilizing the Provider Network Management (PNM) system as well as obtaining and maintaining a Council for Affordable Quality Healthcare (CAQH) Provider Profile.
• Partner with Talent Acquisition and act as a point of contact for new Agency employees, ensuring that all staff who need credentialed (i.e., obtain an OH-ID, NPI, Medicaid Provider# and CAQH Provider Profile) have completed the necessary credentialing activities no later than the staff’s first two weeks of employment.
• Maintain accurate staff affiliations in PNM, including affiliating new staff during onboarding as well as un-affiliating staff upon Agency termination.
• Complete credentialing activities related to commercial payers including, but not limited to, submitting credentialing applications to add providers to insurance panels, communicating with commercial payers to follow-up on status of applications, and responding to re-credentialing requests from commercial payers.
• Maintain up-to-date knowledge of regulations and policies related to provider enrollment.
• All required trainings, certifications and licensure must be kept current in accordance with applicable licensing and accreditation regulations and standards
• Respect the privacy of clients and hold in confidence all information obtained during the client’s treatment. All client-related documents should be handled in accordance with Agency guidelines on confidential material.
• Maintain high standards of ethical and professional conduct and adhere to Agency policies and procedures.
• Perform other duties as assigned by management.

Wingspan Care Group (“Wingspan”) is the not-for-profit parent company of Applewood Centers, Inc., Bellefaire Jewish Children’s Bureau, Bluestone Child & Adolescent Psychiatric Hospital, and Lifeworks. The mission of Wingspan is to provide organizational efficiencies at the operational, administrative, and fiscal levels for its subsidiary agencies so that they may focus on their respective missions. Wingspan is an Equal Opportunity Employer. Wingspan’s policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information, or any other basis protected by applicable federal, state, or local laws. Wingspan also prohibits harassment of applicants or employees based on any of these protected categories.