Credentialing Specialist - Elwyn, PA

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.

• 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

ESSENTIAL FUNCTIONS:

• 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

• 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

• 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 the 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

• 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

• Perform other duties as assigned

• 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