Credentialing Specialist at Willapa Behavioral Health and Wellness – Long Beach, Washington

JOB TITLE: CREDENTIALING SPECIALIST

DEPARTMENT: Administrative

SUPERVISOR: CEO

EXEMPT/NON-EXEMPT: Non-Exempt/Part-Time- 24 hrs. per week + benefits

SUPERVISES: None

JOB SUMMARY:

The Credentialing Specialist/Provider Enrollment is responsible for managing the end-to-end credentialing and enrollment process for clinical providers. This role ensures providers are properly enrolled with payers, maintain active credentials, and meet all regulatory and organizational requirements. The position works closely with billing and care coordination teams to support timely service delivery and reimbursement.

GENERAL RESPONSIBILITIES:

Follow Willapa Behavioral Health & Wellness Service Excellence Standards / Code of Ethics and Policies and Procedures

1. Adhere to rules of confidentiality.
2. Respect and accommodate a diverse population.
3. Maintain appropriate boundaries with clients and staff.
4. Work on-site as necessary or remotely using telehealth technology as determined by management.

ESSENTIAL FUNCTIONS:

Coordinate and complete provider enrollment for National Provider Identifier (NPI) numbers, Medicaid numbers, and CAQH accounts (CAQH-for fully licensed staff).

1. Submit and track private insurance credentialing applications to obtain in-network (panel) status for fully licensed providers
2. Prepare and submit recredentialing applications in accordance with payer requirements and timelines.
3. Verify provider licensure status and ensure all licenses remain active and compliant; proactively monitor and track renewal deadlines.
4. Maintain and update the Managed Care Organization (MCO) roster of billable staff by license level; submit roster updates to MCOs as required.
5. Monitor credentialing timelines and follow up with payers to ensure timely processing and approval.
6. Communicate provider effective dates, credentialing status, and timelines clearly with the billing department and client navigator team.
7. Maintain accurate and organized credentialing records and documentation in compliance with internal policies and external regulations.

JOB REQUIREMENTS:

MINIMUM QUALIFICATIONS:

Experience in provider credentialing, enrollment, or healthcare administration preferred. Knowledge of Medicaid, commercial insurance credentialing processes, and CAQH systems.

1. Strong attention to detail and ability to manage multiple deadlines.
2. Excellent organizational, communication, and follow-up skills.
3. Ability to work collaboratively across departments.
4. High school graduate or equivalent.
5. Excellent verbal and written communication skills, computer proficiency to document in the electronic medical record (EMR) and utilize telehealth and Microsoft office suite.
6. Undergo and pass criminal background check upon initial employment and any subsequent checks required by the agency.
7. Meet requirements of agency’s drug free workplace policy.
8. Excellent customer service with a client focus.
9. Able to sit, stand and move for long hours at a time and lift up to 25 pounds.

PREFERRED QUALIFICATIONS

1. 2 years experience with Provider Credentialing
2. Certification in Health Information Management

RECURRING JOB TRAVEL REQUIRED: ____ Yes __x__ No

If yes, driving record must pass WBHW insurance company’s underwriting guidelines.

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