**** Minimum of 5-years of credentialing/provider enrollment experience is required AND
A Current and Valid CPCS Certification are REQUIRED for this position ****
MAKE A DIFFERENCE AT OCHIN
OCHIN is a rapidly growing national nonprofit health IT organization with two decades of experience transforming health care delivery to drive health equity. We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our mission.
OCHIN provides leading-edge technology, data analytics, research, and support services to nearly 1,000 community health care sites, reaching nearly 6 million patients nationally. We believe that every individual, no matter their race, ethnicity, background, or zip code, should have fair opportunity to achieve their full health potential. Our work addresses differences in health that are systemic, avoidable, and unjust. We partner, learn, innovate, and advocate, in order to close the gap in health for individuals and communities negatively impacted by racism or other structural inequities.
At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture of belonging.
Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of 1000+ diverse professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees’ entire well-being by fostering a healthy work-life balance and equitable opportunity for professional advancement. We are curious, collaborative learners who strive to live our values everyday: Learning, Heart, Belonging, and Impact. OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team.
Base Pay Overview
The typical offer range for this role is minimum to midpoint, with the midpoint representing the average pay in a national market scope for this position. Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will consider a wide range of factors directly relevant to this position, including, but not limited to, skills, knowledge, training, responsibility, and experience, as well as internal equity and alignment with market data.
Position Overview
The Senior Crendentialing Specialist performs all aspects of the credentialing, privileging, and payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties. The Specialist will manage credentialing applications, verify credentials, maintain provider files internally and externally with payor plans.
Essential Duties – ****Sr. Credentialing Specialist MUST hold a valid NAMSS Certification at the time of application****
- Timely processing of initial credentialing and re-credentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards).
- Reviewing and analyzing credentialing applications and supporting documents for accuracy and completeness.
- Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources.
- Identifying discrepancies in information, conducting research and follow-up, and escalation of unresolved issues.
- Completing payer provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system.
- Maintenance of credentialing cycles, Expirables management, and Sanctions monitoring.
- Preparing provider credentialing summaries and reports for OCHIN management and OCHIN Collaborative members.
- External communications with providers, OCHIN Collaborative representatives, contracted third parties, hospitals, specialty boards, and health plans pertaining to credentialing activities.
- Internal communications with other departments related to provider enrollment information.
- Maintaining integrity, confidentiality, and accuracy of provider information.
- Compliance with department standard operating procedures and performance metrics.
- Maintaining current knowledge of credentialing standards and regulations to ensure compliance at a national level.
- Other duties as assigned.
Requirements
- Knowledge of credentialing, privileging, and provider enrollment regulatory standards
- Strong understanding of credentialing databases and reporting tools and/or the ability to quickly learn them
- Detail-oriented, analytical, problem solving, decision-making and organizational skills
- Ability to accomplish responsibilities accurately and expeditiously
- Excellent written, verbal, and interpersonal communication skills
- Proficient computer software and database skills
- Associate’s degree or commensurate experience
- Three (3) years of progressive experience in credentialing and provider enrollment
- NAMSS Certified Provider Credentialing Specialist (CPCS) preferred
Additionaly Qualifications for Senior Credentialing Specialist
- Bachelor’s degree preferred
- Five (5) years of progressive experience in credentialing and provider enrollment is required
- NAMSS Certified Provider Credentialing Specialist (CPCS) required
- Exhibits professional diplomacy while identifying, organizing, facilitating, and/or sustaining mutually beneficial partnerships with internal/external stakeholders
Work Location and Travel Requirements
OCHIN is 100% remote organization. Work from home requirements are:
- Ability to work independently and efficiently from a home office environment
- High Speed Internet Service
- It is a requirement that employees work in a distraction free workplace
- Travel may be required to support our member organizations on-site based on business requirements for OCHIN
