Reference #: 5001082811306 Credentialing Specialist

#ELG-19631 | Posted 11/08/2024 Elwyn, Pennsylvania

Credentialing Specialist

#ELG-19631 | Posted 11/08/2024 | Elwyn, Pennsylvania Apply for this job now!

Job Description

Since 1852, Elwyn has helped people with autism, intellectual, developmental, and behavioral challenges lead meaningful lives. As an internationally recognized nonprofit human services organization, we have always been on the forefront of innovation. Please join us to make a difference in the life quality of children, teens and adults with autism, intellectual and developmental disabilities, and related behavioral health challenges - and feel the resulting pride that will enrich your own life. Providing an excellent benefits package is another way we know that Elwyn is truly a special place to work. We invest in your future while you help care for ours: Generous Paid Time Off

Comprehensive Medical/Dental/Vision Benefit Packages

Earned Wage Access/On-Demand Pay Paid On-the-Job Training

Tuition Reimbursement

Career Advancement Opportunities and Growth

Flexible Schedules

Retirement Savings Plan Elwyn is seeking a Credentialing Specialist (CS) to ensure that all provider credentials, including those of Elwyn employees, provider staff, teachers, and contracted agency staff, comply with program regulations as mandated by state guidelines, the Office of Child Development and Early Learning (OCDEL), the Bureau of Special Education (BSE), the Pennsylvania Department of Education (PDE), and the School-Based Access Program (SBAP). The CS provides direct support to external providers and internal staff, managing data entry, validating credentials, and overseeing database management. The CS utilizes various reports to proactively monitor credentials, issue timely notifications of expirations, and initiate inactive status to maintain 100% program compliance. The CS also manages the offboarding process for internal staff and external providers, maintaining the active staff roster. ESSENTIAL FUNCTIONS: Data Management and Reporting: Perform daily data entry tasks, issue resolution, and updates related to provider credentialing, including CPR and first aid certifications, licenses, certificates of competence, and other SBAP requirements Run reports from Elwyn and state databases (ex., SPROUT, PELICAN, PERMS, PowerSchool) in Excel-compatible formats to ensure regulatory compliance, including proactive expiration reports, missing information reports, expiration reports, ineligibility reports, and ad hoc reports as needed Prepare monthly active and aggregated reports as required or requested by the manager for trend analysis, identification, state reporting, and compliance Communication and Customer Service: Serve as the primary point of contact for new hires, recertification, and employee terminations concerning credentialing; participate in the onboarding process for internal staff and external contractors Provide direct communication and intervention with provider agencies and internal staff regarding credentialing status to resolve issues; deliver high-quality customer service and support for the credentialing process, including timely notifications, responses, dispute resolution, and problem-solving Compliance and Credential Management: Ensure staff and contracted providers are cleared to start by reviewing all credentials and clearances prior to start date and confirming to Elwyn Onboarding and provider agencies that all required items have been received Manage and maintain the master list of active and properly credentialed providers and staff; oversee the master list of inactive providers and staff who have failed to remain properly credentialed for purposes of reinstatement, non-billable time, and removal from service Manage the reinstatement process for providers into the active staff pool once their credentials are renewed and active, as an essential function of th billing process and record-keeping Enforce compliance with deadlines and credential requirements by alerting program liaisons, educational leaders, and directors with regular updates via a 30-day warning and notice of inactive status due to non-compliance Maintain notifications on behalf of Elwyn, resolve discrepancies, and ensure credentialing compliance; activate and inactivate providers and staff who fail to remain credentialed with the program Verify state databases (Professional Education Record Management System (PERMS), Pennsylvania Information Systems (PIMS)) for licensure/credentialing information, and Comprehensive Screening Solutions (CSS) for criminal backgrounds; notify individuals whose credentials are lacking or have lapsed to submit updated credentials to ensure only certified, licensed, and actively credentialed staff provide services, maintaining compliance with funder requirements and local, state, and federal laws Request files and/or documents to conduct regular audits of staff files for accuracy, and verify that hard copies of credentials match the tracking system to ensure all staff have the required active licenses, certifications, and credentials for their roles Collaboration and Support: Assist with provider staff notifications for quarterly Random Moment Time Studies (RMTS) and maintain an accurate staff pool list by providing reminders to ensure completion of the RMTS, including sending timely notifications to staff for RMTS participation, notifying direct supervisors when moments are missed, and ensuring notification completion Collaborate with the billing manager, where applicable, to maximize Medical Assistance (MA) billing through credentialing compliance; maintain a 100% credentialing compliance rate at all times Other Duties: Perform other duties as assigned QUALIFICATIONS, EDUCATION AND EXPERIENCE: High School diploma; associate degree or higher in education, business, computer science, or a related field preferred Two (2) years of experience working with employee data in a business setting One year of experience with credentialing systems and state and educational databases such as PERMS, PIMS, PELICAN, and PowerSchool is preferred Experience using or knowledge of electronic student records is preferred Experience or knowledge in client relations, program management, and data analysis is preferred Non-profit human service experience highly preferred Demonstrated ability to work effectively as part of a team Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities Demonstrated strong attention to detail Demonstrated strong time management and organizational skills Demonstrated ability to anticipate future needed changes or identify problem areas and take effective actions Must possess excellent customer interaction, collaboration, presentation, and written and verbal communication Intermediate-level knowledge of Microsoft Office applications, including Word, Outlook, and proficiency in Excel with knowledge of functions such as pivot tables, vlookup, and basic calculation functions. Excellent customer interaction, collaboration, presentation, and written and verbal communication skills. Ability to enforce rules and regulations in difficult situations and maintain confidentiality of personnel records and organizational information. Knowledge of Electronic Health Record (EHR) / Electronic Medical Record (EMR) preferred PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment c