What are the responsibilities and job description for the Health Plan Credentialing - CME Specialist position at Driscoll Health?
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General Purpose of Job:
Responsible for carrying out the functions of the Driscoll Health Plan HMO credentialing process, Additionally provides support and assistance for other medical staff and provider relations activities. Confidentiality is a key responsibility.
Essential Duties and Responsibilities:
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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.
- Maintains utmost level of confidentiality at all times.
- Adheres to DHS/DHP policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Processes applications both medical staff and applicable allied health professionals for credentialing and recredentialing
- Processes requests for temporary privileges
- Prepares confidential correspondence
- Oversees, develops and maintains credentialing database program
- Maintains all credentials files
- Prepares credentialing profiles and reports
- Monitors database for expirations of required credentials, securing current verification of licensure, DEA, and
- DPS registrations and professional liability insurance
- Oversees and maintains privilege delineation system
- Prepares medical staff roster
- Monitors state and federal sanctions reports
- Oversight of all provider data to be published in GeoAccess prepared provider manuals
Education and/or Experience:
- Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
- Credentialing and/or Health Plan/HMO experience along with computer skills to include Intellicred.