Credentialing Specialist

Description

1.Ensures credentialing processes are completed on time and in compliance with the guidelines of regulatory agencies, including Kentucky Board of Medical Licensure, Nursing Board and other State licensure, The Joint Commission (TJC/JCAHO) and, National Committee for Quality Assurance (NCQA).

2. Closely monitors information collection and follows up to obtain missing documents.

3. Ensures confidential credentials files are orderly and current with all required and received information and will follow up with LIPs to obtain renewal information, including but not limited to licensure, malpractice insurance, DEA, flu, TB, registration/certification and other time limited documents.

4. Performs general office and secretarial work within the normal operation of the Department. This includes checking mail daily and distributing, checking and stamping in all applications. Filing and boxing up credentialing files to take to storage. Ordering supplies and binders.

5. Maintains database of physicians and allied health which includes demographic information, privileges granted, department and committee appointments/attendance, continuing medical education activities, credentialing and other related information.

6. Maintains resignation logs and completes process of physician resignations within the medical staff office.

7. Processes requests for applications, sends Pre-Application form and maintains record of applications sent.

8. Assists in the processing of new applications and reappointment applications per standing Medical Staff Services protocol and Medical Staff and Organizational policies and procedures including entering new providers into the Meditech Provider Dictionary.

9. Maintains personal adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical and Organizational policies.

10. Assures data security and confidentiality of all files by securing appropriate file areas, cabinets, drawers and computer terminals.

11. Coordinates all physician orientations with assistance from medical staff Associates.

12. Maintains record of physician dues, follows up when dues are delinquent and/or ready for processing. Emails all physicians on yearly dues and process dues into medical staff physician dues account.

13. Able to assist with reports as requested through the designated medical staff credentialing software.

14. Coordinates yearly credentialing audits with contracted health insurance entities to come and review credentialing files, policies, procedures and minutes for the Cooperative Care Network.

15. Assists with supporting and processing the Organized Medical Staff’s business matters, including agenda and meeting package preparation, meeting attendance, and the taking and transcribing of meeting minutes. Will Attends any and all aforesaid meetings as needed and/or in the absence of the Director or specialist and takes minutes, transcribes into acceptable organization format and distributes within 3 working days.

16. Schedule room, audio visuals, room layouts, and catering request for all aforementioned meetings

17. Completes all activities involved in preparation of reports, minutes, polices, bylaws, rules and regulations, procedures and correspondence to facilitate department operations.

18. Answers telephone calls and directs to the correct location/department. Answers phones and takes complete and accurate messages and logs for anyone in the office who is away from their desk. Checks routinely the automated phone line for outside business calls.

19. Orders office supplies as need to keep an inventory for use.

20. Responsible for coordinating mailboxes in the medical staff physician lounge.

21. Makes conference/seminar registrations, airlines, hotels, and rental car reservations when requested. 2

22. Coordinates and schedules appointments for the Director as needed for medical staff/physician business matters.

23. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.

24. Resource for Medical Staff projects.

25. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.

26. Contributes to the achievement of the mission, vision, and values of the Organization.

27. Contributes to the effective operations of the Organization by demonstrating dependability in job performance.

28. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).

29. Demonstrates a commitment to the development and implementation of shared governance across the Organization.

30. Performs other related duties assigned in a willing and cooperative manner.

Skills

accounts receivable, Collections, Customer Service, eligibility verification

Top Skills Details

accounts receivable,Collections,Customer Service,eligibility verification

Additional Skills & Qualifications

Must understand Kentucky credentialing processes, payer contracts, and strict 30-day credentialing turnarounds.

Preferably hospital credentialing experience, working with physicians and mid-level staff; experience with all medical staff credentialing is important.

Experience with fluctuating workload (2–20 initial credentials per month; 30 reappointments max).

Danville KY 3 days on site 2 days remote

Experience Level

Entry Level