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Description

Join Chimes – and go further to help others go far! Chimes is a not-for-profit organization that assists people with intellectual and behavioral challenges to achieve their fullest potential.

Our vast array of services — educational, employment, vocational, residential, habilitative and behavioral health — are delivered through a network of national and international affiliates. This allows us to take a comprehensive, holistic approach to improving the lives of every person we serve — those who receive and those who reap the benefits of our innovative, responsive solutions.

GENERAL DESCRIPTION OF POSITION:

Under the direction of the Chief Compliance Officer, the credentialing specialist will maintain provider compliance with the regulatory and quality assurance standards of each funding source with which the organization is contracted. This includes processing credentialing and re-credentialing applications and paperwork for all service providers. Additional focus may include conducting chart audits and investigatory reviews, and monitoring internal processes and controls to ensure compliance with applicable statutory and contractual requirements regarding proper service/billing documentation and prevention/detection of fraud, waste and abuse.

PRIMARY JOB FUNCTION(S):

• Submit credentialing applications and ensure all licensure/certifications are current.
• Conduct audits to ensure compliance with regulatory requirements concerning service delivery documentation.
• Comply with all policies and regulations for credentialing providers.
• Maintain database of timelines and credentialed providers for use by other departments Complete formal audit reports containing findings.
• Assist in investigations of alleged violations of rules, regulations, policies and procedures, related to the prevision/detection of fraud, waste and abuse.
• Assist in developing/implementing corrective action plans for resolution of compliance problems.
• Assists with coordination of program performance improvement program.
• Assists in design of program performance improvement initiatives, measure and analyze progress.
• Assists in development and maintenance of monthly program indicators.
• Conducts random unannounced audits of program monthly indicators and compliance service verifications to assure accuracy and appropriate follow up.
• Assists with development of annual Performance Improvement Report.
• Present trainings to staff on compliance/quality assurance topics.
• Maintain professional relationships with staff, clients, payers, other agencies.
• Attend relevant meetings, external and internal, and participate in agency committees as assigned by supervisors.
• Other responsibilities as assigned.

REQUIREMENT QUALIFICATION:

Minimum Education: Bachelor’s Degree. All degree(s) must be from a regionally accredited institution of higher learning.

Minimum Experience: 5 years administrative experience in behavioral health or other healthcare field.

What’s in it for you?

Total Rewards (For Full-Time Employees = >30 hours/week):

• Competitive Pay
• Medical, Dental, and Vision Insurance
• Tuition Reimbursement options
• Flexible Spending Accounts (Health, Dependent, and Transportation)
• Life Insurance
• Disability Insurance
• Paid Time Off
• 403(b) with Employer Match
• Employee Recognition Programs
• Employee Referral Bonus opportunities
• Discounts through “Tickets at Work”
• Discounts on Verizon mobile service
• And More!

Want to learn more?

To learn more about Chimes, and how you can achieve personal and professional growth within a purpose-driven organization, visit us at: https://chimes.org/Careers.