Credentialing Specialist

Working Title: Credentialing Specialist
Program: Finance
Pay Range:$20.63-22.74
Location: The Dalles 
FTE: 1.0 FTE (37.5 hours per Week)
FSLA Status: Non - Exempt Mid-Columbia Center for Living (MCCFL) is a Certified Community Behavioral Health Clinic (CCBHC) that specializes in providing services that are both trauma-informed and recovery-oriented to persons / consumers with mental illness and addictions. Trauma-informed care includes safety, choice, collaboration, trustworthiness and empowerment for both clients and staff. MCCFL serves Hood River, Wasco and Sherman Counties and utilizes a consumer-involved, consumer-engaged and consumer-driven model. MCCFL provides a whole-person care approach to adults and children to address both physical and mental health needs. MCCFL offers a variety of programs including a mobile crisis unit, intensive case management, ongoing counseling, community support, supported employment, jail diversion, hospital discharges, hearings and more. Classification General Statement :
The Credentialing Specialist is responsible for managing relationships with insurance companies and MCCFL providers to ensure timely credentialing and payor enrollment of all new and existing providers.  This position will be responsible for insurance verification of clients to ensure communication of coverage or lack of coverage with the client and MCCFL. Position-Specific Essential Responsibilities of the Credentialing Specialist: Facilitate the credentialing process for and with providers to complete provider enrollment with insurance companies and payers. Monitor and meet compliance timelines for all enrollment/credentialing requirements, and provide updates as needed. Create and maintain internal credential/insurance processes; assess the agency credentialing process, making recommendations to ensure effective, timely, and compliant processes. Coordinate the receipt and processing of all credentialing data needed for enrollment, contracting, and other related purposes. Update provider credentialing data in databases, such as, electronic health record, or other related applications. Work closely with providers to obtain missing documentation and signatures pertaining to provider enrollment. Follow up with payers on documentation submitted. Coordinate provider enrollment information with the Finance team for billing of services. Obtain and maintain up-to-date copies of provider credentials, including, primary source verification of current state licenses, certifications and required credentialing documents for all providers.  Facilitate insurance verification process for scheduled clients and educate coworkers on the insurance verification process to accommodate clients who present for services without an appointment.  Communicate insurance verification results for clients without coverage to coworkers for assistance with insurance enrollment; provide information to help with rescheduling when insurance coverage is available.   Maintain timeliness completion of all records, notes, and other required documentation. Complete additional ad hoc projects and reports, as assigned. Ability to function as a member of a team and participate in all team and agency meetings as scheduled. Regular and reliable attendance; timely and professional communication; maintain confidentiality where required. Job Specifications High school diploma or GED and two (2) years of office support or administrative tasks/experience is required. One year of credentialing and/or insurance enrollment experience is preferred. Certified Provider Credentialing Specialist (CPCS) Certification is preferred. Must possess a valid Oregon or Washington Driver's license and be insurable for infrequent travel between business offices or possess an alternative reliable mode of transportation. Must pass all criminal history check requirements as required by ORS 181.536-181.537 and in accordance with OAR ******** – ******** . Other Required Knowledge, Skills and Abilities : Other Required Knowledge, Skills and Abilities: Knowledge: Knowledge of office functions, including staff scheduling and workflow; knowledge of the principles and practices associated with modern clerical support work; knowledge of business English and grammar; knowledge of medical terminology and electronic health record systems; knowledge of basic bookkeeping; strong knowledge of standard office equipment and multi-line telephone systems; general knowledge of symptoms and challenges faced by people with mental illness; general knowledge of community resources available to mental health consumers. Skill: Strong skill in keyboarding and data entry; strong skill in the use of standard office software, including MS Excel and Word; skill in the use of database software. Interpersonal skills to support customer service, functional, and teammate support needs. Ability to work independently. Ability: Ability to have excellent organizational skills, a strong attention to detail and to communicate effectively in both written and verbal communications. Ability to understand and effectively apply the concepts and practices of a trauma-informed philosophy in performing the work. Ability to work within strong professional ethics and rules of confidentiality to provide effective services. Ability to project a positive, professional image of MCCFL; ability to maintain a strong service orientation; ability to organize and execute work to maintain an effective work flow in the office; ability to discern appropriate responses and alternatives, and apply judgment within established parameters; ability to follow established procedures and work productively under general supervision; ability to work with grace and good humor, sometimes in difficult interpersonal exchanges with clients; ability to work independently and cooperatively with other departments and community partners. Leadership Received :
This position works under the direct supervisory leadership of the Finance Director.  The designated supervision emphasizes independence of method and process while indicating accountability for results. Leadership Exercised :
This position is not responsible for providing supervisory leadership to any other classification. Physical Demands : While performing the essential duties of this position, the employee is regularly required to use office equipment including computer and phone system that requires fine manipulation, grasping, typing, and reaching. The employee may be required to sit or stand for several hours at a time, depending on environment and need. This position may occasionally be required to lift up to twenty (20) pounds, and to kneel, reach, bend or squat while in the office or in the community. Specific vision abilities required by this job include close vision, peripheral vision, and depth of perception, the ability to adjust focus, and distance vision (if driving). The employee should possess reliable transportation for vehicle travel between business offices in order to attend required meetings and/or trainings. Work Environment :
Work is performed in various settings, including office environment, clinic, community settings and other agency stakeholder facilities. The office environment is typically with moderate stimuli and may often result in exposure to increased sensory experiences. Community settings may pose additional risks or discomforts which require safety precautions.
While this description is intended to accurately reflect the activities and requirements of the Credentialing Specialist position, management reserves the right to modify, add or remove duties as necessary. Job responsibilities are subject to possible modification to reasonably accommodate the needs of the individuals served by this agency. This document does not create an employment contract, implied or otherwise, other than an "at will" employment relationship.

  MCCFL provides reasonable accommodations for qualified individuals with disabilities. To request accommodation in the recruitment or selection process, please contact human resources at or email .