Community Action Committee of Pike County

Position Title:

Insurance Credentialing/340B Support Specialist

Department:

Fiscal

Reports To:

Finance Manager

Program Director:

Assistant Executive Director for Finance

FTE:

1.0

FLSA Designation:

Non-exempt

EEOC Category:

Professional

Pay Level:

G1

Effective Date:

HR Approval:

Employee Signature:

www.pikecac.org

OUR MISSION…

It is the mission of the Community Action Committee of Pike County to end poverty by empowering and improving people's lives while building strong communities.

OUR VISION...

It is the vision of the Community Action Committee of Pike County to grow independently, healthy lives while leading the charge to end poverty.

OUR LOCATIONS…

Piketon

Waverly

Jackson

Portsmouth – Broadway

West Portsmouth

Manchester

OUR PROGRAMS & SERVICES…

• Early Childhood & Head Start

• Energy & Weatherization

• Workforce & Business Development

• Senior Programs

• Community Action Transit System (CATS)

• Social Services

• Pike Mobility Management

• Health Insurance Marketplace Assistance

• Women, Infants, & Children (WIC)

• Free Tax Preparation

• Valley View Health Centers

• Primary Care

• General Dentistry

EQUAL OPPORTUNITY COMMITMENT…

Community Action Committee of Pike County is an equal opportunity employer. No personnel decisions concerning any term or condition of employment shall be based upon race, color, religion, sex, sexual orientation, national origin, ancestry, disability, Vietnam-era status, age, military status, place of birth, or genetic information, except where such criteria constitute a bona fide occupational requirement.

About Community Action Committee of Pike County…

Since 1966, the Community Action Committee of Pike County has been providing a broad base of much needed services to residents of Southern Ohio to promote self-sufficiency and to address the major causes of poverty. We are an embodiment of our nation’s spirit of hope – changing people’s lives and improving the communities we serve.

About CAC Leadership and Program Support…

CAC leadership and program support is comprised of the offices Administration, Fiscal, Human Resources, and Information Technology. Together, these departments play an integral role in helping our programs to live-out the mission, vision, and core values of the Community Action Agency of Pike County – everyday. We provide expertise and assistance with strategic planning, fiscal opportunities and financial management, risk management and compliance, employee relations and performance management, technology and systems solutions, leadership development, and organizational excellence. We strive to be forward-thinking and innovated in our approach to moving the agency forward and to improve the well-being and independence of those we serve.

Position Impact and Purpose…

The Insurance Credentialing 340B Support Specialist’s primary job is to ensure that the personnel of Valley View Health Center (VVHC) are properly licensed and certified as mandated by state and federal regulations with appropriate insurance companies. In addition, they ensure that all insurance credentialing of providers is in compliance with state and federal government agencies. They verify both individual and facility accreditation, maintain records of verification and work with auditors as needed. This role is vital to maintaining compliance and to providing billable services in order to generate revenue.

Key Relationships…

• Assistant Executive Director for Finance

• Managed Care Companies

• Insurance Plan Providers

• Direct Supervisor

• Billing Supervisor

• Patient Access Manager & Representatives

• Billing Staff

• VVHC Administrative Assistant

• Internal Controls/340B Program Manager

• Credentialing & Enrollment Representatives

• Care Providers

• VVHC Leadership Team

Key Characteristics and Competencies…

• Working knowledge of medical credentialing procedures

• Excellent Attention to Detail

• Self-Motivated

• Accountability

• Research Skills

• Integrity

• Excellent Communication

• Data Analysis & Interpretation

• Solutions Focus

• Proficient in Microsoft Office Products

• Organization Skills

• Positive Outlook

• Confidential – HIPPA

• Multi-task

• Professional

• Accurate

Essential Functions…

Functional Area:

Insurance Credentialing

Estimated Effort:85%

Responsibilities, Deliverables, Outcomes and Expectations

• Complete site and provider credentialing/re-credentialing applications with contracted insurance companies, Managed Care Companies, and other accrediting entities.

• Ensure all insurance credentialing applications and forms are completed accurately, thoroughly, and timely.

• Monitor the status of each providers insurance credentialing and re-credentialing. Following-up with credentialing entities to ensure provider credentialing is completed timely. Assist providers through the insurance credentialing process, and follow up on missing documents to ensure completion of the credentialing process.

• Communicate status of provider credentialing to applicable practices and management.

• Sets up and maintains provider information in an organized and systematic manner.

• Maintain insurance credentialing files and documentation.

• Responsible for the initial registration and continuing update of the providers in the Council for Affordable Quality Healthcare’s Universal Credentialing Data Source (CAQH)

• Responsible for completion of outstanding requirements to complete credentialing process (NPI, PECOS, etc.)

• Must keep up to date with changes in credentialing guidelines.

• Maintain a good working relationship with Insurance Companies.

Functional Area:

340B Support

Estimated Effort:10%

Responsibilities, Deliverables, Outcomes and Expectations

• Provide 340B support to the 340B Program Manager.

• Conduct 340B audits as assigned.

• Assist in monitoring 340B guidance and or rule changes.

• Attend quarterly 340B Compliance meetings

• Be the backup for the 340B Program Manager in regards to processing daily claim reviews in the Third Party Administrator Portal.

• Run reports within the 340B Third Party Administrator Portal and be able to analyze them to ensure compliance.

Functional Area:

Collaboration and Support

Estimated Effort:5%

Responsibilities, Deliverables, Outcomes and Expectations

• Attend meetings, conferences, and training sessions related to the duties of this position. Disseminate acquired information to appropriate individuals inside and outside of the agency.

• Serves as a representative of the fiscal department on assigned CAC committees.

• Maintain a great working relationship with people within and outside of the agency.

• Serve as cash receipts backup

• Assist in performing task necessary to achieve the organizations mission. Any other duties needed to help drive our vision, fulfill our mission, and abide by the organizations values.

Minimum Requirements…

Education:

High School Diploma or Equivalent

Job-Related Experience:

Two (2) years of experience in insurance credentialing, CAQH and NPPES.

Three (3) years’ experience in a medical office setting.

Preferred Qualifications…

Associate’s degree in Business and/or Health Administration or comparable work experience.

At least one (1) year of experience in a Community Health Center setting.

Knowledge of medical terminology.

Auditing experienced.

Working Conditions…

Position is in a well-lighted office environment. Telecommuting is possible in this role but will still be required to come into the office when needed. Work is fast paced and involves multiple, sometimes competing priorities along with the management of complex project details.