Provider Credentialing/Privileging Clerk

Title: Provider Credentialing/Privileging Clerk 

Reporting Relationship:  Chief Executive Officer

The Provider Enrollment and Credentialing Clerk is responsible for managing the provider enrollment and credentialing process from start to finish, including follow up on application status and troubleshoot any issues that may arise. In addition, supporting the Executive Assistant and the GNMSS Administrative assistant, this position is a support person to help with handling routine functions, such as informational requests and routine correspondence; coordinates the overall functions of CEO Suite in conjunction with the Executive Assistant.  This position must possess strengths of organization, timeliness, and have the ability to perform secretarial and general clerical duties independently and on his/her own initiative.  This position assist in coordinating and implementing credentialing and privileging activities within the Credentialing and Privileging Office. This role involves the appointment, reappointment, and ongoing verification of the Medical Staff and Allied Health Professional Staff entities. The clerk will investigate and document practitioner credentials, ensuring compliance with various regulatory standards and maintaining accurate documentation for review by licensing agencies. The Provider Enrollment and Credentialing Clerk will also be responsible for credentialing and recredentialing of the hospital and clinics.  This position will also set-up and maintain CAQH accounts.

1. Manages time well, demonstrates extreme organization and attention to detail. Demonstrates the ability to anticipate and prepare needed materials, establish priorities, summarize incoming materials and data, and draw attention to detail and correct problems as needed.
2. Manages the provider enrollment and credentialing process from start to finish. Follow up on application status and troubleshoot any issues that may arise.
3. As a Provider Enrollment & Credentialing Clerk, you will ensure that the hospital's healthcare providers are properly enrolled and credentialed by insurance companies and regulatory bodies
4. Assists in the review of medical staff and allied health practitioner appointment and reappointment applications for appropriateness of data against department and external requirements when needed.
5. Determine primary sources for verifications in accordance with accreditation standards and locum tenens’ agreements.
6. Verify and document verification as required by external standards in the practitioner file, performing follow-up and second source verification as necessary.
7. Evaluate all verifications for discrepancies and notify supervisors of adverse or questionable responses.
8. Documenting the results of all verifications and inquiries, maintaining the credentialing and privileging software system for tracking activities.
9. Maintain credential files for the Medical Staff according to Medical Staff Bylaws and regulatory agencies.
10. Assist in organizing and developing the monthly Credentialing Committee agenda.
11. Follow up on application status and troubleshoot any issues that may arise
12. Assist with accurate records of provider credentials, licenses, and certifications
13. Ensure compliance with all relevant regulations and accreditation standards
14. Collaborate with internal departments, such as billing and compliance, to facilitate the enrollment and credentialing process
15. Stay up-to-date on changes in enrollment and credentialing requirements
16. Provide reports and updates to management on enrollment and credentialing status
17. Assist with audits and accreditation surveys as needed
18. Manage the process of privileging providers at other entities
19. Obtain malpractice insurance for all providers through the CFO office. Maintain and report on the status of each provider in the credentialing, enrollment and privileging process
20. Manages credentialing and recredentialing for Hospital and Clinics will all insurance companies.
21. Maintains CAQH accounts and performs re-attestations as required.
22. Additional duties as assigned
23. Relays requests to the Chief Executive Officer for action from Medical providers, nursing staff, front line staff, as well as BBGH facility wide personnel.

Other Job Functions: 

1. Works collaboratively with the Executive Assistant and GNMSS Administrative Assistant on projects on Medical Staff Credentialing Application submission for Medical Executive Committee and Board of Trustee approval according to the Joint Commission Standards.
2. Perform value-added activities that result in positive financial performance and customer satisfaction.
3. Performs other related duties as assigned or requested.           

• 19 years of age or older unless otherwise noted in the position summary.

• Required:
  • High School Degree or G.E.D. Equivalent.   

Required:

• At least one year experience as an administrative or executive level assistant or secretary.
• Proficient and or advanced computer skills and experience with programs including, but not limited to: Microsoft Word, Excel, Publisher, EMR or EHR(or similar medical software), and Internet Explorer.

Preferred:

• Three or more years’ experience as an administrative assistant, secretary and/or office manager in an outpatient hospital-owned practice.

• Required:
  • Valid Driver's License
• 
  Preferred:
  • Certified Rural Health Clinic Professional

• Expected work hours up to - 8

Post-offer/per-employment background check and drug screen are required.

Box Butte General Hospital is an Equal Opportunity Employer.