DescriptionSHIFT: No Weekends
JOB TITLE: Credentialing Specialist
GENERAL SUMMARY OF DUTIES – This position will be responsible for supporting the development and implementation of the Credentialing Processing Center policies and procedures. This will include, but not be limited to responsibility for credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review. Excellent communication and relationship building skills are required. Will be expected to assist the Manager and Director with other tasks/projects as requested. All activities will be performed for select HCA hospitals within established levels. Compliance with HMA policy and procedure, Federal and State regulatory and accrediting agencies is required.
SUPERVISOR – CPC Manager
SUPERVISES – N/A
TRANSITION DUTIES INCLUDE BUT ARE NOT LIMITED TO:
• Assist in planning, developing, implementing process and documentation of processes during migration
• Assist in establishing, reviewing, and implementing quality controls and reviews during migration
• Provide input for process design and other implementation activities
• Manual entry of practitioner data
• Primary Source Verification of selected items
DUTIES INCLUDE BUT ARE NOT LIMITED TO
• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy and procedure
• Assist in the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes
• Acts as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to clients in a timely manner
• Process and maintain credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations.
This will include but not limited to the following verifications:
National Practitioner Data Bank OIG/GSA fro Medicare/Medicaid exemption
DEA Verification Licensure Board Certification Training verified. Residency/ Fellowship Peer Recommendation Professional Schooling Verified
• Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure
• Monitor collection of all information received; follow up on missing items and/or incomplete forms per CPC policy and procedure, submit follow up requests for verifications as needed
• Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response
• Advise Manager and/or Director of questionable information received and any issues identified during the processes
• Submit closed files for audit/final review and secure missing items as identified by audit/final review
• Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements
• Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies as required
• Perform other duties and works on special projects as requested
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Perform other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
• Organization – proactively prioritizes needs and effectively manages resources. Ability to show attention to detail.
• Communication – communicates clearly and concisely. Must have excellent interpersonal and written communication skills. This includes spelling and grammar skills and basic mathematical calculations.
• Customer orientation – establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies & Procedures – articulates knowledge and understanding of organizational policies, procedures, and systems.
• PC Skills – demonstrates proficiency in Microsoft Office (Excel, Access, Word) applications and other as required.
• Ability to maintain confidentiality of privileged information gained.
• Ability to work independently and under pressure.
• Credentialing & Privileging technical skills –credentialing process and primary source verification knowledge.
• Associate degree or an equivalent combination of education and experience required. Bachelor Degree preferred.
• Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office)
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
• Demonstrated working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
• Completion of post Cactus training testing of 85% or greater
• Understanding of professional telephone etiquette
• Able to work with minimal supervision and works well in both individual and group environment
CERTIFICATE/LICENSE - NAMSS certified at CPCS level preferred, or a commitment to pursue certification within one year
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