What are the responsibilities and job description for the Credentialing & HR Specialist position at New Horizons Healthcare?
Credentialing Specialist
Duties And Responsibilities
Duties And Responsibilities
Duties And Responsibilities
- Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and NHH regulations, guidelines, policies, and standards.
- Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and NHH criteria.
- Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems with credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
- Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
- Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
- Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
- Communicates clearly with providers, their liaisons, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
- Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
- Performs miscellaneous job-related duties as assigned.
Duties And Responsibilities
- Assists with recruitment effort for all exempt and nonexempt personnel, students and temporary employees; conducts new employee orientations; monitors career-pathing program; and writes and places advertisements.
- Help perform benefits administration, including claims resolution, change reporting, approving invoices for payment and communicating benefits information to employees.
- Handles employee relations counseling, outplacement counseling and exit interviewing, and Virginia Employment Commission requests and hearing.
- Administers various human resource plans and procedures for all organization personnel; plan and oversees the on-boarding process for new employees; assist in the development and implementation of personnel policies and procedures; prepares and maintains the employee handbook.
- Maintains human resource information system records and compiles reports from database
- Participates in developing department staffing goals, objectives and systems.
- Monitors the performance evaluation program and revisions as necessary. Provides information to ensure that supervisors/ managers remain on track with regular performance evaluation schedules.
- Assists in evaluation of reports, personnel decisions and results in relation to established goals.
- Recommend new approaches, policies, policies and procedures to continually improve efficiency of the department and services performed.
- Attention to detail.
- Ability to meet strict deadlines.
- Excellent organizational skills.
- Willingness to collaborate across departments.
- Ability to communicate effectively both orally and in writing.
- Customer service skills.
- Ability to respond to emails timely and effectively.
- Information research skills.
- Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
- Working knowledge of clinical operations and procedures.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
- Ability to make administrative/procedural decisions and judgments.
- Demonstrated advanced working knowledge of Microsoft Word and Excel.
- Ability to learn new applications to function effectively.
- Skill in establishing priorities with independent coordination of day-to-day aspects.
- Associate degree in healthcare or business administration preferred, not required.
- Certified Provider Credentialing Specialist (CPCS) certifications preferred, not required.
- Specialist certifications through the National Association of Medical Staff Services (NAMSS) preferred, not required.
