Credentialing Specialist

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Milwaukee County offers a wide variety of interesting jobs for people who want to make a difference in our community. Milwaukee County provides a competitive benefit package and is an Equal Opportunity Employer.  If disability related accommodations are needed, please contact 414-278-3936.
 

We are searching for Changemakers to come and join our team and discover our diverse and versatile community of independent spirits and unique talents, we are redefining the way you think about Milwaukee County!

Closing Date: July 7^th, 2024, or upon receipt of 50 applicant submissions

Credentialing Specialist

Department of Health & Human Services (DHHS)

Hourly Range - $19.49 - $29.24

Job Summary: Under the direction of the Contracts and DHHS Quality Assurance Manager, the Credentialing Specialist ensures all caregivers providing direct or indirect services under DHHS contracts meet all the credentialing and onboarding/impaneling requirements as well as the program qualifications required by the State and DHHS policy. This positions reviews, analyzes, and processes provider applications, certificates of insurance, staff add/drop requests, requests to be credentialed, and impaneled.

Job Duties:

• Ensure all components are submitted and complete. Process and reviewing applications, staff add/drops, background checks, credentials, DOJ/DHS letters, etc. Process applications and review/finalize paperwork related to determination of eligibility.
• Process and review applications to credential new AODA and DHHS provider agencies. Review all relevant requirements (e.g., licenses, NPI# and MA certification verification, OIG status, etc.). Prepare correspondence for eligibility determination, and/or incomplete applications and documents.  
• Update vendor or individual provider related information in software application; including adding or deleting providers from network or modification of services for approved providers. Update resource guides, contract entries, as well as maintain up-to-date service descriptions and updated reimbursement rates as needed.
• Respond to provider questions about various aspects of the provider network and application process; process and log completed applications in Avatar and Staff Roster; prepare correspondence for eligibility determination, and/or incomplete applications.
• Prepare and update presentation materials and handouts for orientations. Assist with the preparation of new, renewal, etc. agreements. Schedule in-service for vendors to review updates and policy changes, etc. Prepare packets for vendors and make copies of materials, etc.      
• Maintain processes which support the DHHS network for contracted providers by testing and troubleshooting network problems and concerns. Analyze network adequacy and utilization throughout provision of services, collecting feedback from programmatic staff regarding potential network shortages.
• Support Contract Administration Department with operations by working on special projects to identify or support the departments efficient operations daily.
• Manage the provider and credentialing shared mailboxes; maintain minutes/notes for Provider Network and Credentialing Committee meetings; assist with questions from vendors on AVATAR, and handle DHHS Fiscal requests related to AVATAR and billing issues.
• Perform all other duties as assigned.

Minimum Required Qualifications:

• Current resident of the State of Wisconsin
• Candidates with the following education and experience will qualify:
  • Bachelor’s degree in Social Services, Health or Human Service field, or closely related field.
    • OR
  • High School Diploma/GED Equivalent and two (2) years of experience working in Credentialing or Quality Assurance support role, or closely related role. – Administrative roles, skills, office.
• Proficiency in Microsoft Office Software
• Demonstrated excellent customer service skills.
• This position requires a high level of attention to detail.

Preferred Qualifications:

• Experience with onboarding staff and reviewing personnel files
• Familiarity with contracting or provider network environment
• Knowledge of Social Services or Behavioral Healthcare
• Ability to work in an environment quickly changing demands

Additional Knowledge, Skills, and Abilities:  Knowledge of Federal, State, and local laws governing Milwaukee County contracts; oral and written communication skills; ability to write reports; skill in database management, word processing and spreadsheet software applications; research skills; organizational skills; ability to work effectively and harmoniously with vendors, county staff, and other governmental agencies, and ability to lift/carry/push/pull up to 10 lbs. occasionally.

NOTE: This ORIGINAL APPLICATION is open to all qualified residents of the State of Wisconsin. Candidates will be asked to submit a full account of their training and experience (i.e., by submitting a resume or by fully completing an application) in this electronic process and may also be asked to take a written or performance tests as part of the selection process.

APPLICANTS MUST POSSESS MINIMUM QUALIFICATIONS AT TIME OF FILING APPLICATION.

Milwaukee County is committed to fostering an equitable working environment, free from discrimination and harassment, on the basis of any characteristic protected by law. We prohibit any form of discrimination, harassment based on race, color, religion, sex, gender, gender identity or expression, sexual orientation, pregnancy, pregnancy related condition, national origin, age, disability, FMLA status, sexual orientation, military status, marital status, or any other category or status that is now or in the future protected by federal, state, and local law. We maintain a drug-free workplace and perform pre-employment substance abuse testing, background checks and pre-employment physicals subject to job requirements. If special accommodations are needed, please contact 414-278-3936.