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Credentialing Specialist
3 months ago
JOB SUMMARY:
This position is responsible for establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff office and physicians.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Upholds and supports the mission, philosophy, objectives, policies and ethics of CHSI.
2. Protects organization’s value by keeping information confidential.
3. Carries out and completes the credentialing process for new and existing Providers.
4. Monitors, updates and advises supervisors of Provider and clinic licenses to ensure they are kept current.
5. Conducts pre-employment data query on Provider applicants.
6. Understands and carries out the necessary process to ensure laws and regulations concerning Provider credentialing and clinic licensing are met.
7. Queries electronically the National Practitioner Data Bank for initial appointment, reappointments, change in privileges, and temporary privileges for each clinic.
8. Processes all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet clinic operation policies and procedures.
9. Maintains up-to-date license and certified Provider database, including medical licenses, drug enforcement administration (DEA) certificates, malpractice insurance, and renewal period expiration dates.
10. Communicate with Medical/Dental Directors continually and provides monthly about expiration reports and provide rosters when requested.
11. Maintains organized credential files and assists with inspections by regulatory authorities or accreditation surveyors, and ensures that all information meets federal and state guidelines when processing applications.
12. Ensures all requests for privileges are processed in a timely manner.
13. Ensures credentialing files are kept current and are in compliance.
14. Responds to provider inquiries received by letter, phone, email or internal departments.
Credentialing Specialist | Pg. 2 of 2
15. Perform all other duties as directed either formally or informally, verbally or in writing.
Company DescriptionCommunity Health Systems, Inc (CHSI) is a Federally Qualified Health Center (FQHC) and Non-Profit 501 (C)(3), operating six community health centers in the tri-county area of: San Bernardino, Riverside, and San Diego.
CHSI focuses on providing high quality and compassionate medical, dental, women’s health, behavioral health, and vision care services to those who are under-served, uninsured, or under-insured.
Community Health Systems, Inc. is a non-profit 501 (c) (3) 330 HRSA Grantee with Federally Qualified Health Center (FQHC) status. Established from the roots of Bloomington Community Health Center in Bloomington, CHSI has grown with community health centers in the counties of Riverside, San Bernardino, and San Diego. These centers have been developed in accordance with standards established for safety net providers by the U.S. Department of Health and Human Services (HHS), the Health Resources Services Administration (HRSA), the Public Health Service (PHS), and the Bureau of Primary Health Care (BPHC). The mission of CHSI is not to compete with other clinics that provide healthcare services, but to serve the indigent population and meet their healthcare needs.Company DescriptionCommunity Health Systems, Inc (CHSI) is a Federally Qualified Health Center (FQHC) and Non-Profit 501 (C)(3), operating six community health centers in the tri-county area of: San Bernardino, Riverside, and San Diego. \r
CHSI focuses on providing high quality and compassionate medical, dental, women’s health, behavioral health, and vision care services to those who are under-served, uninsured, or under-insured. \r
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Community Health Systems, Inc. is a non-profit 501 (c) (3) 330 HRSA Grantee with Federally Qualified Health Center (FQHC) status. Established from the roots of Bloomington Community Health Center in Bloomington, CHSI has grown with community health centers in the counties of Riverside, San Bernardino, and San Diego. These centers have been developed in accordance with standards established for safety net providers by the U.S. Department of Health and Human Services (HHS), the Health Resources Services Administration (HRSA), the Public Health Service (PHS), and the Bureau of Primary Health Care (BPHC). The mission of CHSI is not to compete with other clinics that provide healthcare services, but to serve the indigent population and meet their healthcare needs.
