Credentialing Specialist (Enrollment)

Description

MAKE A DIFFERENCE AT OCHIN

OCHIN is a nonprofit leader in health care innovation and a trusted partner to a growing national provider network, delivering the clinical insights and tailored technologies needed to expand patient access, strengthen care teams, and improve the health of rural and medically underserved communities.

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 vision of good health and well-being for everyone.

At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture rooted in our values.

Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 1,200 skilled 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 opportunity for professional advancement. We are curious, collaborative learners who strive to live our values every day. 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.

Position Overview:

The Credentialing Specialist performs all aspects of the credentialing, privileging, and payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties. The Business Partner – Credentialing Specialist will manage credentialing applications, verify credentials, and maintain provider files internally and externally with payor plans.

Essential Functions:

• •Timely processing of initial credentialing and recredentialing 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 escalating unresolved issues.
• •Completing payor provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system.
• •Other duties as assigned.

Requirements

• •Minimum of two (2) years of progressive experience in Credentialing and/or Provider Enrollment preferred.
• •In-depth knowledge of credentialing, privileging and provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) preferred.
• •Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred.
• •Proficiency in credentialing software and data management systems is preferred.
• •Experience in MD-Staff preferred.
• •Advanced Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) preferred.
• •Working knowledge of Smartsheet including data structure, formula creation, basic workflows and automation preferred.
• •Proven experience in client-facing roles, with the ability to build strong relationships and communicate effectively with diverse stakeholders preferred.
• •Familiarity with Jira for issue tracking and task management preferred.

Hiring Process

During the selection process, candidates will be prompted to complete a pass/fail computer literacy assessment and a competency assessment. These assessments help us better understand each candidate’s strengths, preferences, and work style and are one of several tools used in the selection process.

Work Location and Travel Requirements

OCHIN is a 100% remote organization with no physical corporate office location. Employees work remotely from home, and many of our positions also support our member organizations on-site for new software installations. Nationwide travel is determined based on OCHIN business needs. Please inquire during the interview process about travel requirements for this position.

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 nationally based on business requirements for OCHIN
• •In alignment with OCHIN’s mission and commitment to protecting our workforce and the communities we serve, OCHIN strongly encourages all workforce members, especially those whose role involves travel and in-person engagement, to remain up to date on immunizations, including but not limited to COVID-19 and influenza vaccinations.

We offer a comprehensive range of benefits. See our website for details: https://ochin.org/careers

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Base Pay Overview

OCHIN uses broadened pay ranges to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data.

Work Authorization

Candidates must be legally authorized to work in the United States on a permanent basis at the time of application. This position is not eligible for employment visa sponsorship now or in the future. OCHIN does not provide sponsorship for employment-based visas or transfers of existing employment-based visas.

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