Job Description
Job Description
At Cenevia, we eliminate operational burdens so our healthcare delivery champions can focus on providing high-quality and cost-effective health outcomes. Since 1996, Cenevia has been a trusted support system, training partner and business process expert for health providers, including Federally Qualified Health Centers (FQHC), private practices, hospitals, managed care organizations, and provider networks.
Cenevia provides integrated, network-based services and programs to healthcare clients to help them run their businesses better so that they can focus on patient care. This includes the centralized practice management system, help desk, and support infrastructure that Cenevia established in 1999.
The Cenevia staff includes experienced health care professionals from the following areas :
- Quality Improvement
- Health Information Technology
- Revenue Cycle Management
- Health Plan Contracting
- Credentialing and Enrollment (NCQA-certified)
Summary / Objective :
This non-exempt position performs administrative duties requiring accuracy and attention to detail in the credentialing / recredentialing process. Maintains continuous contact with internal and external customers, including practitioners, administrators and support staff. Additionally, this position is responsible for communicating provider information to stated internal and external customers through established processes for credentialing / recredentialing.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.
Essential Functions :
Core duties and responsibilities include the following. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Other credentialing and enrollment duties may be assigned.
Serve as subject matter expert in Credentialing activities for department.Serve as subject matter expert in Credentialing activities for department.Assist departmental leadership with day-to-day departmental administration and operationsAssist leadership with departmental reporting and metrics towards efficient processes and deliverablesServe as liaison with other departments as point of contact on Credentialing and Enrollment matters and initiativesResponsible for creation and maintenance of departmental new hire training and cross training program developmentResponsible for new employee departmental onboarding and integration to increase optimal performance outcomesResponsible for Credentialing Committee meetings and drafting minutes if neededPrepares files and supporting data for Credentials Committee meetingParticipation in departmental strategic planning efforts and related meetingsManual Entry of Practitioner information into the credentialing database in a timely mannerAbility to read, extract and interpret information comparing such to established departmental policies. Maintains a computerized database of practitioner data for use in the credentialing & enrollment processExcellent verbal and written communication skillsSelf-motivated with the ability to complete projects independently within established timelinesEnsure workload deadlines are being met in a consistent mannerMust be flexible and willing to work extra hours during peak workloads and deadlinesAbility to problem solve, make decisions and effectively communicateAbility to work productively within a teamPrepares and provides reports, recredentialing applications, status reports, expired items reports and completed file reports to assure time frames are met and filing and scanning when necessaryAccurately perform a variety of administrative duties such as : placing calls, processing facsimile verifications, scanning, sending written inquires, filing and copying.Ensures consistent & complete verification of practitioners credentialing / recredentialingMaintains a computerized database of practitioner data for use in the credentialing / recredentialingGenerates verification letters, and upon receipt of verification letters, logs the appropriate response in the Credentialing databaseMaintains detailed credentialing / recredentialing files in electronic format, including electronically received documents, and document each stage of credentialing / recredentialing process thoroughlyEnsure workload deadlines are being met in a consistent mannerDevelops and maintains good working relationships with practitioners and support staff to obtain necessary and timely information to facilitate the provider enrollment / reenrollment process if applicableWorks collaboratively with fellow team members to maintain department workflows, processes, policies and systems. Additionally, each team member is expected to cross-train on location and provider type / group or plan type requirements to assist one another in completing assigned duties as the enrollment cycle warrantsAbility to independently resolve problems, make decisions, and negotiate issues as neededTracking of provider credentialing / recredentialing applications timely for the closure of practitioner filesCompetence in displaying superior customer service skillsProduce an end-of-day report identifying activities accomplished to be copied to the CEO for reviewQUALIFICATIONS :
High School diploma or GED requiredPreferred one (1) year experience in healthcare credentialing (i.e., healthcare facility, credentials verification organization, or Medical Staff Office)Preferred working knowledge of the health care and credentialing industry, regulatory agencies, and other national standardsAble to work with minimal supervision and ability to work well in both individual and group environmentExperience with Microsoft Word Office SuiteCOMPETENCIES :
To perform the job successfully, an individual should demonstrate the following competencies :
Adaptability Dealing effectively with change and acclimating / adjusting to a dynamic environment.Admin Compliance Adhering to appropriate SOP's [Standard Operating Procedures], guidelines, parameters, standards, policy, procedure, and / or protocols.Client Focus Anticipating, understanding, and fulfilling customer needs and expectations by providing excellent direct and indirect service.Communication Conveying and receiving information and ideas efficiently and effectively through a variety of organizational mediums.Problem Solving Using problem analysis skills to identify and define issues for resolution and choosing optimum courses of action.Productivity Ensuring efficiency requirements are met even in the face of time or resource restrictions.Skills Demonstrating sincere interpersonal sensitivity with regard to self's and others' comfort, feelings, worth, and well-being.Teamwork Working effectively as part of a team through the practices of subordination, support, and cooperation.PHYSICAL DEMANDS :
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk.
The employee must occasionally lift and / or move up to 10 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
WORK ENVIRONMENT :
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually moderate.
Cenevia is an equal opportunity employer.
At Cenevia, we believe diversity brings strength and adaptability by drawing on a broad range of talents, experiences and perspectives, and affords an inclusive workplace and culture where all people, regardless of gender, race, ethnicity, sexual orientation, or background, feel a sense of belonging.
This position is remote, and employee must have suitable and secure technology to be eligible for consideration – e.g., secure Wi-Fi, telephone, dedicated workspace. Additionally, employee is required to participate and be seen in meetings via video conference as part of this role.
