Note: Although this is a fully-remote position, applicants MUST reside in Oregon or Washington in order to qualify for employment with Outside In.

Outside In is accepting applications for a full-time, 40 hrs per week, Credentialing Specialist to work with our Compliance Manager to help ensure insurance credentialing applications are being completed and that data needed from program staff are provided in a timely manner.

This position is eligible to receive a one-time $1,500 bonus, added to their first paycheck (if start date is on or before 02/28/2023), and a one-time $1,500 retention bonus, added to their paycheck 6 months later (on or before 08/28/2023)

This position has a starting pay range of $17.22 to $21.81, based on experience and skills. Additionally, if hired at a step lower than $21.60, a differential will be added to your base rate to equal a total rate of $21.60 to meet our updated Living Wage pay base.

Position Summary

The Credentialing Specialist maintains insurance credentialing applications and processes at Outside In. This position manages day-to-day tasks; monitors and manages credentialing and re-credentialing, communicates with clinicians/providers directly, manages data within credentialing databases from delegated entities, supports the credentialing team with other credentialing needs.

Essential Duties

• Initiate and maintain credentialing applications and processes between each individual billable clinician/provider and each of our contracted insurances.
• Initiate and maintain credentialing applications and processes between Outside In locations and contracted insurances.
• Monitors requests for and receipt of credentialing and recredentialing applications.
• Support clinician/provider completion of credentialing and recredentialing applications; monitor applications and follows-up as needed;
• Identifies and reports any non-compliance or credentialing issues.
• Communicates with clinicians/providers directly or with appropriate office staff regarding the credentialing process, submitted application status and required documentation requests.
• Manages provider data within the credentialing database from delegated entities.
• Assures confidentiality of documents, records and data information. Keeps all documents secure and confidential.
• Supports credentialing team with any other credentialing needs

Knowledge and Skills

Knowledge

• Familiarity with Credentialing processes and applications: preferably CAQH, Availity, MMIS, Pecos and more
• Proficient computer skills, including basic office machines including organizational databases, fax, copier, scanner and PC
• Able to make decisions within the boundaries of established policy and procedure of the department.
• Adapt to new technology and software
• Supports Agency mission and goals

Skills

• Capable of working independently and collaboratively.
• Well-organized and detail-oriented.
• Good communication skills.

Education and Experience

• High School Diploma or GED, or sufficient experience required to show organization and workplace skills.
• Demonstrable experience with HIPAA and confidentiality
• Competency and comfort with technology
• Detail aware
• Experience with insurance credentialing such as Medicare (CMS) and State of Oregon Medicaid (DMAP) credentialing requirements preferred.
• Certification for credentialing preferred