Federal Certification and Credentialing Specialist

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Job Summary:

Provide licensing and administrative support within the Compliance Department. Duties may include assisting with coordination and completion of required licensure and credentialing applications and renewals, contacting the licensing agencies to complete applications and renewals, acting as an Internal and external resource for questions regarding licensing Issues, as well as providing general administrative support. Supervises, and mentors the licensing and credentialing team.

Essential Functions:

• Compile, analyze, interpret, and communicate healthcare and business licensing requirements as relevant to emerging, newly acquired, or ongoing In-home care business activities.
• Research and assist in the development, implementation of regulatory policies and procedures to ensure that all required licenses are Identified, applied for, renewed, and properly monitored.
• Coordinate to ensure timely and thorough completion of all required licensure applications and renewals.
• Contact licensing agencies, Internal and external personnel, and any/all other parties necessary to complete licensing applications and renewals in accordance with licensing agency requirements.
• Troubleshoot any potential barriers to licensing/renewals.
• Collect, organize, file, and manage license applications and renewals documentation to ensure ease of access and proper monitoring.
• Document licensing updates; report status updates to management; provide recommendations to resolve or correct any Issues Identified by the licensing/renewal process. Communicate with urgency any Issues of concern.
• Work closely with management to ensure that emerging or newly acquired business activities meet all relevant licensing and regulatory requirements. Assist in developing and updating policy and procedure manuals. Serve as an Internal resource for questions regarding licensing and regulatory issues.
• Provide general administrative support within the Compliance Department, as directed, including but not limited to assisting in acquisition activity, reviewing/proofreading various legal documents and correspondence, calendaring litigation deadlines, maintain contracts database, and drafting correspondence.
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements.
• Maintain contracts with all payers.
• Develop and maintain processes that provide timely notification of critical contract events.
• Communicate contractual terms to all appropriate staff and ensure they are informed of changes in medical and billing policies.
Responsible for the accuracy of supporting documentation for contracts and completing documents accurately and timely.

Additional Responsibilities:

• Performs other duties as assigned or requested.
• Conforms to all applicable Agency policies and procedures.
• Participates actively in continuing education and in-services.
• Maintains confidentiality of patient information and business trade practices

Knowledge / Skills / Abilities:

• Organizational skills
• Ability to supervise in accordance with Agency’s policies and applicable laws.
• Ability to respond to common inquiries or complaints, regulatory agencies, or members of the business community.
• Time management
• Cooperative attitude
• Advanced written and verbal interpersonal communication

Information Management:

• Treats all information and data within the scope of the position with appropriate confidentiality and security.

Risk Management:

• Cooperates fully in all risk management activities and investigations.
• Keeps abreast of changes in health care law.
Maintains Agency/program compliance with local, state, and federal laws as well as state accreditation standards.

Minimum Position Qualifications:

• Education:
  • Associates Degree from an accredited college or Certified Paralegal
• Experience:
  • Minimum of 1 year experience in a healthcare or legal environment.
  • Experience in regulator or compliance role, preferably in healthcare or other regulated industry
• License / Certification:
  • Driver’s license and proof of current auto liability insurance; no listing in the OIG Excluded Provider listing
  
  

Environmental Conditions: Works under a variety of conditions in facilities and offices; ability to work flexible schedule, ability to travel locally; some exposure to unpleasant weather. Moderate noise level; tasks may involve exposure to bloodborne pathogens; moderate stress and emotional demands.

Physical Requirements: Sitting is required. Requires ability to always handle stressful situations in a calm and courteous manner. Requires working under some stressful conditions to meet deadlines and agency needs. Ability to travel.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities.