Overall Mission: Responsible for accurate and timely provider credentialing support and file maintenance.
Benefits Include: Zero cost for single/individual BCBS health; life, AD&D, STD, and LTD; Cafeteria Plan (FSA & DCA); optional dental, vision, life, critical illness, and retirement with 50% match; generous paid time off and extended leave; 15 recognized holidays; and more.
Minimum Requirements: Associate’s degree in healthcare administration or general business; One-year experience in healthcare administration, credentialing individual providers and facilities; Proficient in medical terminology and clinical process/applications; Strong attention to detail; Current/valid Alabama driver’s license, acceptable auto insurance limits, good driving record, and proof of COVID-19 vaccination(s); Must successfully complete and pass pre-employment process.
Preferred Qualifications: Bachelor’s degree in healthcare administration or business administration; Two years’ experience in healthcare administration, credentialing individual providers and facilities.
Areas of Responsibility
1. Create and maintain licensing, credentials and insurance records.
2. Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
3. Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
4. Work with individual providers to ensure each provider s CAQH database files are updated timely according to the schedule published by CMS Medicare/ Medicaid and Managed Care Organizations regulations.
5. Assist new individual provider completing application for National Provider Identifier (NPI).
6. Terminating enrollment with government and commercial payers upon resignation or termination of providers.
7. As directed, provide updated demographic information with supporting documents to outside participants, such as commercial managed care plans and contracted billing entities.
8. Work closely with the Executive Director and Clinical Director to ensure all individual providers are credentialed and recredentialed timely.
9. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
10. Responsible of ensuring provider collected information is current and accurate.
11. Responsible of coordinating, monitoring, and maintaining the credentialing and recredentialing process and contracting processes with insurance companies.
12. Insuring interpretation and compliance with the appropriate accrediting and regulatory agencies.
13. Contacting Managed Care Organizations, Commercial plans, CMS Medicare, and Medicaid and/or other insurance agencies to follow up on several stages in credentialing.
14. Conduct research on updated state and federal regulations and policies.
15. Release information to requesting agencies and public inquiries when required by law.
16. Help develop internal credentialing processes.
17. Monitor license and credential expiration dates and advise staff members of required “renew by” dates.
18. Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions.
19. Other duties as assigned.
Work Environment
1. Schedule: Work hours are full time and may occasionally include nights and/or weekends; varies based on the needs of the client, the client’s family, and the agency.
2. Physical: May lift up to 50 lb. occasionally; prolonged periods of standing, stooping, bending, and sitting. Employee must be able to climb stairs, able to read documents and respond to written communication, and able to hear and understand the English language.
3. Cultural: Must be comfortable working with individuals and/or family members living with HIV (or other STIs), as well as those with impaired cognitive behaviors, individuals experiencing homelessness, LGBTQ individuals, and members of various racial/ethnic communities.
Overall Expectations
The employee will be expected to represent the agency in person and through all other methods of communication in a way that reflects the agency’s mission. Staff are expected to adhere to all AIDS Alabama Policies, Procedures, and Guidelines (including, but not limited to, Personnel/Human Resources, Finance, Operational, and Housing) as presented and as adapted. The employee will establish a strong, solid line of communication with all levels of staff and external business partners. All employees are expected to perform and communicate openly, effectively, and professionally with staff members, consumers, community members, and external business partners. Candidates must be willing and able to complete all training in obligatory timeframes. Staff participation in agency activities, testing events, and fundraisers is expected as necessary and requested. Be aware that any breach of confidentiality is grounds for dismissal. This job description can be modified to reflect additional tasks.
AIDS Alabama expects staff to create a safe space where all people are valued, respected, and treated with dignity; sexuality is accepted as a healthy part of being human. In such a space, all people would be celebrated for who they are and provided with the economic, educational, and social opportunities to reach their full potential.
AIDS Alabama is an equal opportunity employer.
To apply please visitwww.aidsalabama.org/joinourteam
Pay: $38,000.00 - $45,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
