Credentialing Specialist

Description

JOB PURPOSE:  Responsible for all aspects of provider credentialing and re-credentialing with insurance companies, the hospitals, clinics and any other patient care facilities.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Set up and maintains provider information online credentialing databases.
• Manages workload to meet deadlines and maintain department standards on turnaround time to insure timely payor effective.
• Communicates with providers to obtain requisite credentialing information to facilitate timely completion and submission of required documents.
• Facilitate physician applications, notify all necessary personnel and review applications for competency and licensing.
• Track and monitor processing and completion of applications at all hospitals.
• Monitor providers health files and assist the Employee Health nurses at the facilities in receiving the required paperwork.
• Run primary source verifications including, but not limited to National Practitioner Databank (NPDB), Background checks, American Medical Association (AMA), American Osteopathic Information Association (AOiA), CertiFacts, National Student Clearinghouse, American Association of Nurse Practitioners (AANP), Educationsl Commission for Foreign Medical Graduates (ECFMG), Office of Inspector General (OIG), System for Awards Management (SAM).
• Notify providers, copying administration, of licenses and certifications expiring in advance and send weekly reminders until license/certificates are updated.
• Acts as a liaison and credentialing resource for medical staff members and medical staff office personnel.
• Maintain credentialing files.
• Other duties as assigned.

BEHAVIORAL STANDARDS

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in everyday work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Participate in performance improvement activities utilizing principles to support and improve departmental goals.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions and best practices.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

QUALIFICATIONS:

• Experience in physician credentialing required
• Two years of relevant experience in hospital and/or healthcare credentialing.
• Demonstrates oral and written communication skills to obtain and convey information clearly, accurately and in a timely manner. Ability to compose and create logical and grammatically correct correspondence.
• Ability to work efficiently with minimum supervision and set priorities to meet varying demands, changes in priorities and competing
• Excellent interpersonal skills to effectively interact with all levels of staff and facility
• Excellent organizational skills
• Ability to maintain confidentiality in handling sensitive documents and
• Skills in operating PC hardware
• Knowledge of Adobe and Microsoft Outlook, Excel, and Word
• Able to communicate effectively in English, both verbally and in writing.

EDUCATION/CERTIFICATION/LICENSURE:

• High School Diploma or GED required, Associates degree or Bachelors degree in a healthcare related field preferred.
• Medical staff services certification preferred:
  • Certified Professional Medical Services Management (CPMSM) or
  • Certified Provider Credentialing Specialist (CPCS) or
  • Education plan to obtain in 12 months

PHYSICAL REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
• This job requires visual abilities, auditory abilities, must be intact to perform duties.

Qualifications