What are the responsibilities and job description for the Credentialing Specialist position at The GW Medical Faculty Associates?
Please note this role will be hybrid Remote Monday & Friday in office Tuesday-Thursday.
About GW MFA
MFA physicians provide comprehensive patient care, offering one practice for the whole person with 52 medical and surgical specialties. As members of the GW School of Medicine and Health Sciences faculty, MFA providers are teachers and mentors for medical students, residents, fellows, and researchers preserving the rich tradition of academics, research, and healing. In addition to maintaining a closely integrated alliance with The George Washington University and The George Washington University Hospital (GWUH) which is separately owned and operated by Universal Health Services (UHS), the GW MFA has active referring relationships with 12 area hospitals.
The GW MFA's leading healthcare presence in the DC metro region is complemented by a network of community-based practices in DC, Maryland, and Virginia. Given its geographic location in central NW Washington, DC, and proximity to more than 175 resident embassies, the MFA continues to evolve its international clinical outreach.
Position Summary
Perform day-to-day credentialing and re-credentialing activities for providers within the Credentialing Department. Performs payor enrollment and maintenance with payors on a regular basis. Maintain customer-focused relationships with MFA departmental contacts to ensure a smooth and efficient credentialing process.
Essential Duties and Responsibilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
Credentialing & Privileging - conduct and participate in credentialing and privileging activities (40%)
- Determine the practitioner's eligibility for membership / participation to ensure compliance with accreditation and regulatory standards.
- Distribute and track all credentialing application packets requested by MFA department contacts for prospective practitioners.
- Utilize the CAQH database to retrieve and analyze practitioner applications and supporting documentation for completeness according to accreditation and regulatory standards.
- Inform practitioner and MFA department contacts of the application status, and resolve pending issues, including the collection of additional information.
- Ensure compliance with accreditation and regulatory standards by processing initial and reappointment applications for eligible practitioners.
- Compile, evaluate, and present practitioner files for committee review to ensure compliance with accreditation and regulatory standards.
- Complete practitioners' enrollment applications into DC Medicaid, Maryland Medicaid, Virginia Medicaid, Medicare, and Tricare.
- Ensure the provider numbers for the governmental payors are loaded in the billing system to ensure the timely release of claims to the payors.
- Complete the revalidation / re-enrollment application into DC Medicaid, Maryland Medicaid, Virginia Medicaid, and Medicare for each practitioner every five years.
- Update the medical / professional licenses that are about to expire with DC Medicaid, Maryland Medicaid, and Virginia Medicaid.
- Work with the billing department to make sure rejections for credentialing-related reasons are addressed in a timely fashion and the charges are resubmitted for payment.
Primary Source Verification - Conduct primary source verification activities (20%)
Compliance - Comply with accreditation and regulatory standards (15%)
Operations - Support departmental / organizational operations (25%)
Minimum Qualifications
Education
Experience
Physical Requirements
Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
