Caravel Autism Health

Role Description The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts. - Responsible for the oversight of all credentialing activities, including completion and submission of applications and following up with providers and payors on incomplete items. - Works with payors to add new locations to existing contracts. - Maintains good working relationships with payor contacts. - Performs initial review of new payor contracts and suggests changes to discuss with Director. - Acts as a credentialing resource for providers. - Ensures department operations are performed in an accurate and timely manner. - Identifies and suggests process improvement goals to support operations. - Develops and maintains partnerships across all other departments, partners, and vendors to develop and integrate solutions in support of business objectives. Non-Essential Functions/Other Duties: - Performs other duties as assigned. Supervisory Responsibility: - Leads, coaches, and mentors Billing & Authorization Staff. Travel Required: - Occasional travel may be required. Physical Demands: - This is largely a sedentary role, with frequent sitting and computer keyboarding required. - Employee will be required to sit, talk, hear, type, and write. - Occasional bending, squatting, stooping, and lifting (up to 35 pounds) are required. Qualifications - Education: At least a Bachelor’s Degree in a healthcare or business related discipline, or equivalent experience. Certification is a plus. - Experience: At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity. Previous management level experience preferred. - Skills and Competencies: - Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts. - Strategic focus, with the ability to identify and execute on key business strategies that will support attainment of overall organizational business objectives. - Ability to effectively lead, coach, manage, mentor and develop others, holding staff accountable as appropriate. - Excellent interpersonal skills, with the ability to communicate effectively with others. - Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere. - Displays professionalism and represents organization in a professional manner. - Strong knowledge of HIPAA privacy and security rules and regulations. Benefits - Compensation: $18.18 to $20.00, depending on qualifications, skills, competencies, and experience. - Competitive wages with excellent benefits, including: - Medical and dental insurance. - Employer-matched 401(k). - Paid time-off. - Paid travel. - Short-term disability. - And more. Company Description Credentialing Specialist is a Full Time remote/work from home opportunity, and we are open to candidates in the Spokane, WA OR Green Bay, WI areas.

• Support the design, administration, and evaluation of employee benefit programs • Analyze data to identify trends, cost drivers, participation patterns, and opportunities for improvement • Serve as a point of contact for employee benefit questions • Maintain benefits data integrity in HRIS systems • Assist with compliance activities such as ACA reporting, ERISA requirements, COBRA administration, FMLA. • Evaluate vendor performance and collaborate with brokers, carriers, and third-party administrators. • Participate in special projects such as plan redesign, benchmarking studies, and process improvements.