What are the responsibilities and job description for the Credentialing Specialist position at QHR Health, LLC dba Ovation Healthcare?
Welcome to Ovation Healthcare!
At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.
We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com.
Summary:
Credentialing Specialists ensure that medical staff members maintain current credentials and licenses to work legally in their field or specialty. These specialists monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. They also review information on potential new employees to make sure all required licenses and credentials are current before hiring.
Credentialing specialists often work independently. This requires the specialist to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals, office personnel, and the public is standard.
Duties & Responsibilities:
Maintain compliance with all regulatory and accrediting institutions.
Monitor staff credentials and licenses.
Advise staff on renewal procedures.
Participate in the development of internal credentialing processes.
Keep records in licenses, credentials, and insurance contracts.
Release information to agencies and members of the public as required by law.
Evaluate all new credentialing packets to ensure all documentation is present and accurate.
Input provider demographics in the credentialing database system.
Complete and submit enrollments with insurance carriers.
Carriers will include those whose rules and guidelines are universal.
Track enrollments for developments.
Follow up on application status and release claims when complete.
Update carrier portals and CAQH with updated licensures.
Maintain CAQH attestation for all providers.
Help other teams in the department when necessary.