What are the responsibilities and job description for the Credentialing Specialist position at ASCENSION DEPAUL SERVICES?
JOB DESCRIPTION
Position: Credentialing Specialist
Status: Full Time
GENERAL JOB DESCRIPTION
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare and Medicaid.
DUTIES & RESPONSIBILITIES
Conducts initial preparation and credentialing of applications within established Fair Credit Reporting Act (FCRA) and company guidelines
Credential professional clinical staff in accordance with the policies of State of Louisiana, and off-site client locations, The Joint Commission (TJC), and/or CMS/Medicare requirements.
Maintain Council for Affordable Quality Healthcare (CAQH) database for all providers on a quarterly basis.
Work with the Corporate Responsibility Officer to assure that all risk management concerns are addressed.
Verify that all items on the credentialing checklist are either obtain or performed,( ie. verification of Malpractice insurance, obtaining Louisiana Controlled Dangerous Substances (CDS licenses, etc).
Responsible for enrolling all medical providers in all applicable government and or commercial insurance plans.
Perform all duties necessary to operate a credentialing program that supports initial appointments and reappointments: enter data and maintain accurate, current and complete credentialing database systems.
Review provider credentialing information for accuracy, completeness and follow-up in a timely fashion with providers, references and other sources to obtain missing information.
Design, implement, maintain and integrate a credentialing procedures checklist to address risk management concerns for all ADS contracted sites.
Prepare educational materials, interpret policies and procedures, attend credentialing committee meetings, etc., for faculty and professional staff as requested.
Participate in all regulatory site visits at off-site locations; summarize/distribute credentialing updates from the Board of Trustees, etc., as appropriate.
Monitor performance improvement aspects of credentialing function for faculty and professional staff at contracted sites; document appropriate privileging activity at off-site locations.
Log, maintain and track all credentialing applications for the Clinic utilizing the applicable tracking tool (green screen/Excel spreadsheet.
Initial review of application to verify all required sections are completed
Establish and process appropriate documents for requested access with insurance websites and government agencies for accurate/current i.e. business license, articles of incorporation, vendor references, etc).
Conduct initial contact with applicant and coordinate requests for required documents
Complete site inspection pre-notification and order/receive and score site inspection.
Monitor and respond to inquiries from Clinic departments and external insurance carriers regarding status of applications in credentialing
Submits completed credentialing packages to respective insurance carriers via the determined method of submission (fax, email, US Postal, etc.).
PHYSICAL DEMANDS
Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times.
WORK ENVIRONMENT
Work is normally performed inside with a controlled climate.
MINIMUM QUALIFICATIONS
Bachelor’s degree or equivalent; or a minimum of (5) years related experience and/or training; or equivalent combination of education and experience.
Ability to work independently and make intelligent decisions based on the information provided.
PREFERRED QUALIFICATIONS
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
