Management Analyst 1 (Credentialing)
Job ID: 107686
Location: Oregon City, Oregon
Full/Part Time: Full Time
Regular/Temporary:Regular
CLACKAMAS COUNTY CORE VALUES
Clackamas County employees work to serve the public and enrich our community. In that spirit, we pledge to hold ourselves to these standards at all times in our interactions with customers and one another:
• Service
• Professionalism
• Integrity
• Respect
• Individual accountability
• Trust
By incorporating these values into our daily routines, we can better serve our customers, ourselves and our projects. We're always looking to improve. That's the Clackamas County SPIRIT.
https://www.clackamas.us/countyadmin/spirit
Clackamas County is committed to building a community where people thrive, have a sense of safety, connection, and belonging, so that everyone is honored and celebrated for the richness in diversity they bring.
We encourage applicants of diverse backgrounds and lived experience to apply.
CLOSE DATE
This Job Posting closes at 11:59 p.m. (Pacific Time) on Monday, November 18, 2024.
PAY AND BENEFITS
Annual Pay Range: $66,387.83- $84,239.67
Hourly Pay Range: $31.917226 - $40.499840
Salary offers will be made within the posted pay range and will be based on a candidate's experience (paid or unpaid) that is directly relevant to the position.
Clackamas County proudly offers an attractive compensation and benefits package, including competitive wages, cost-of-living adjustments, merit increases (for eligible employees), and a robust sick and vacation plan for regular status employees.
We encourage and support employee health and wellness by offering, health and wellness classes and events, and alternative care benefits, so you can customize your wellness needs to fit your lifestyle.
Employee benefits become effective the first of the month following an employee's date of hire.
Attractive benefits package and incentives for employees in regular status positions are detailed below.
Generous paid time off package, including:
• 12 hours of vacation accrued per month
• Eligible newly hired employees will have the one-time option to frontload their first year of vacation accruals in compliance with https://dochub.clackamas.us/documents/drupal/a51ff5d3-d243-49ba-aa11-15324f4c0bf8! This means you have access to vacation time at time of hire.
• 8 hours of sick accrued per month
• 10 paid holidays and 1 personal day per year
Other Benefits:
• Membership in the Public Employees Retirement System (PERS)/Oregon Public Service Retirement Plan (OPSRP):
• Employer paid 6% PERS retirement contribution (The county currently pays the employee's share of the retirement contribution.)
• OPSRP members get vested after five years of contributions or when they reach age 65
• A Choice of Medical Plans that include chiropractic coverage, alternative care, vision, and prescription drug coverage
• A Choice of Dental Plans
• Robust EAP and wellness programs, including gym discounts and wellness education classes
• Longevity pay
• Other retirement Savings Options that allow for additional retirement funds savings, including an option to contribute a portion of employee earnings on a pre or post-tax basis to a 457b Deferred Compensation Plan
• A variety of additional optional benefits (see links below for additional information)
This is a full time County position represented by the Employees' Association.
https://dochub.clackamas.us/documents/drupal/1e311321-f9ff-4daa-8753-bbdfb4e8d1b4
http://www.clackamas.us/des/benefits.html
JOB DETAILS AND QUALIFICATIONS
Clackamas County's Health Centers Division is looking to fill a vital role as Management Analyst 1. This position plays a critical role in the credentialing and enrollment process for healthcare providers. The Management Analyst 1 is responsible for verifying the qualifications and credentials of providers, facilitating the credentialing and re-credentialing processes, maintaining provider databases, and ensuring compliance with regulatory requirements. This role will collaborate with various departments and external stakeholders to support provider enrollment with insurance companies and maintain positive relationships with payers.
The Management Analyst 1 is responsible for ensuring thorough verification processes for healthcare providers, including conducting primary source verifications of licenses, certifications, and experience for initial and re-appointments, while also assisting with National Provider Identifier (NPI) enrollment and performing queries with the National Practitioner Data Bank (NPDB). The role involves facilitating timely credentialing and re-credentialing processes to ensure provider enrollment with insurance companies and maintaining positive relationships with carriers for efficient reimbursements.
Key responsibilities include conducting primary source verifications of licenses, certifications, and experience; facilitating provider enrollment with insurance companies; maintaining provider databases; and ensuring compliance with regulatory standards. The role requires effective communication with clinical leadership, billing, and HR, as well as collaboration on special projects and programs related to provider incentives and student loan repayment.
The ideal candidate for the Management Analyst 1 position with the Health Centers' credentialing team will have proven experience in credentialing or provider enrollment in a healthcare setting. They will demonstrate strong technical proficiency in data entry and management of sensitive information, with familiarity with federal and state enrollment systems such as NPPES and PECOS. Exceptional attention to detail, analytical and problem-solving skills, and excellent verbal and written communication abilities are essential for effectively collaborating with clinical leadership, providers, and insurance carriers. The candidate should possess strong interpersonal skills, adaptability, a proactive approach to work, and a commitment to confidentiality and compliance. A willingness to stay updated on industry trends and regulatory changes will further enhance their effectiveness in this role.
Minimum Qualifications*:
• A minimum of three (3) years of related experience that would provide the required knowledge and skills to perform the responsibilities of this position.
• Proven experience in credentialing or provider enrollment, preferably in a healthcare setting
• Knowledge of regulatory standards and requirements related to provider credentialing and enrollment
• Strong attention to detail and organizational skills
• Proficient in data entry and managing sensitive information
• Excellent communication and interpersonal skills
Preferred Qualifications:
• Certified Provider Credentialing Specialist Certification
• CAQH or other credentialing database experience
• Oregon Medicaid and Medicare credentialing experience
• Familiarity or experience with provider enrollment systems such as NPPES, MMIS, and PECOS
Pre-Employment Requirements:
• Must pass post-offer, pre-employment drug test. https://dochub.clackamas.us/documents/drupal/69fd8013-4594-4afd-bee9-f1e0aeab42ea
• Must pass a criminal history check which may include national or state fingerprint records check
*For Veterans qualified for Veteran's Preference: If you believe you have skills that would transfer well to this position and/or special qualifications that relate to this position, please list those skills and/or qualifications in the open-ended question at the end of the application and explain how those skills and/or qualifications relate to this position.
TYPICAL TASKS
Conduct initial and renewal verifications of licenses, registrations, certifications, education, training, insurance, affiliations, and experience. Gather peer and professional references and recommendations. Assist providers in enrolling for a National Provider Identifier (NPI). Execute National Practitioner Data Bank (NPDB) queries, review professional liability claims history, and check for Medicare sanctions.
Facilitate the credentialing and re-credentialing process for providers, ensuring their enrollment with insurance companies and payers is completed. Foster positive relationships with insurance carriers to support timely reimbursements, resolve issues, and enhance plan participation.
Enter sensitive provider information into federal and state provider enrollment systems. Demonstrate knowledge and technical proficiency in using systems such as the National Plan and Provider Enumeration System (NPPES), Medicaid Management Information System (MMIS), licensing boards, Oregon Practitioner Credentialing Application (OPCA), Provider Enrollment Chain and Ownership System (PECOS), and CMS Identity and Access Management System.
Maintain the provider database, tracking provider numbers, appointment and re-appointment dates, license expiration dates, registration/certification, and credentialing status with insurers. Notify providers when updates are needed for licenses, registrations, certifications, etc. Collect and ensure the completeness, accuracy, and confidentiality of credentialing files, including provider documentation, NPDB results, education verification, credentialing applications, state licenses, NPI verification, and Medicaid verification as applicable.
Prepare and process credentialing applications and files for review by the Medical Director and Health Centers Director at the time of appointment and re-appointment. Create and submit monthly credentialing and re-credentialing profile documents for presentation at the Community Health Council. Assist with supplemental oversight packets for Medical Directors.
Coordinate Clackamas Health Centers' participation in federal and state provider incentive programs, including student loan repayment programs. Administer these programs and ensure compliance.
Communicate effectively with clinical leadership, providers, billing, HR, and credentialing staff regarding credentialing, privileging, and scheduling. Maintain open lines of communication with provider staff, clinical leadership, and administration to identify and address issues promptly. Alert clinical leadership, Quality Assurance staff, and/or the billing team to emerging problems. Assist with the orientation of new providers as needed.
Gather supporting documentation for privileging requests, obtain information on procedures performed, and track requests for additional privileges.
Document and understand regulatory requirements for an effective credentialing process. Develop and update workflows and documentation relevant to credentialing and provider enrollment to enhance departmental efficiency. Assist in the creation of necessary policies and documents, as well as preparation of forms and materials related to quality improvement or audits.
Participate in special projects aimed at correcting claims related to enrollment. Provide ad hoc reports as needed or requested.
WORK SCHEDULE
This position is included in the County's alternate workweek program, working 40 hours during a standard workweek of Monday through Thursday (Fridays off). Specific hours of work will be discussed with the candidate selected for this position at the time an offer of employment is extended. This position is eligible for hybrid on-site/telework subject to the https://dochub.clackamas.us/documents/drupal/9065b5fb-2237-47ce-9534-e7c8c40fc2bc and based on the Department's business needs.
The exact amount of on-site/telework and schedule will be discussed with the hiring manager during time of offer. Telework locations cannot be located outside of Oregon or Washington. Washington residents must perform 50% of their time on-site at Clackamas County.
EXPLORE CLACKAMAS COUNTY
Clackamas County is in a prime location in the Portland, Oregon metropolitan area and is recognized nationally as one of the most livable areas in the United States. Located on the southern edge of the City of Portland and extending to the top of Mt. Hood, Clackamas County is part of a thriving region in the Northwest. It has a population of about 420,000 residents.
http://www.clackamas.us/
http://www.clackamas.us/onboarding/
https://www.mthoodterritory.com/
ABOUT THE DEPARTMENT
Clackamas County Health Centers provide direct medical, dental, and mental health services to Clackamas County residents.
We provide services at our Integrated Primary Health Care Clinics, our mental health clinics, or through our School Based Health Centers.
Health Centers is a Division of the http://www.clackamas.us/h3s/
http://www.clackamas.us/healthcenters/
Health, Housing, and Human Services (H3S) consists of six divisions, dedicated to ensuring health families and strong communities in Clackamas County.
Mission Statement: We lead and learn with equity in serving individuals, families, and communities by providing access to high quality healthcare, housing, and services that strengthen social and economic resilience.
Vision Statement: Individuals, families, and communities are resilient and thriving.
H3S is committed to improving programs and ensuring better outcomes for the people served, and focuses on the following goals:
• EMPOWERED AND THRIVING STAFF - H3S staff are empowered, engaged and have a sense of belonging while being valued and supported to thrive.
• EQUITY DRIVEN SERVICES - H3S promotes and provides accessible, equitable and culturally responsive services.
• ORGANIZATIONAL EXCELLENCE & CONTINUOUS QUALITY IMPROVEMENT - H3S operates consistently, efficiently and effectively as a cohesive department, using our individual and collective skills and expertise.
APPLICATION PROCESS
Clackamas County only accepts online applications.
Help With Your Application:
https://dochub.clackamas.us/documents/drupal/6b3147a3-bf84-4f52-8238-64a37e936b4f
https://www.clackamas.us/jobs#helpwiththeapplication
If you have any questions or issues you may contact the Department of Human Resources at 503-655-8459 or mailto:jobs@co.clackamas.or.us?subject=Application%20Materials%20Question. Our office hours are Monday - Thursday 7:00 a.m. - 6:00 p.m. Pacific Time (closed on Fridays).
HOW TO CLAIM VETERAN'S PREFERENCE
https://www.clackamas.us/des/jobs.html
https://dochub.clackamas.us/documents/drupal/a67ee11c-861c-4126-aa5a-4dec6174f6eb
VISA SPONSORSHIP
Clackamas County does not offer visa sponsorships. Once a job applicant has accepted a position, they will be required to complete an I-9 and confirm authorization to work in the United States prior to their first day.
EQUAL EMPLOYMENT OPPORTUNITY
Clackamas County is an Equal Opportunity Employer. We value diversity, equity, and inclusion as essential elements that create and foster a welcoming workplace. All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.
If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the Department of Human Resources prior to the recruitment close date. You may request an accommodation during the online application process.
RECRUITING QUESTIONS?
E.D. Barnett, Recruiter
mailto:EBarnettHerro@clackamas.us?subject=RECRUITMENT%20QUESTIONS
To apply, visit https://apptrkr.com/5776333
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