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Credentialing Specialist

4 months ago

Alice, United States Community Action Corporation of South Texas Full time
Job DescriptionJob DescriptionGeneral Summary


The Credentialing Specialist will be responsible for credentialing and privileging providers and clinic support staff as well as other key staff positions for the community health centers. The Specialist will be responsible for all credentialing and privileging of clinic staff. The Specialist will be responsible for assuring that all compliance requirements for health center staff are met and documented.

Primary Responsibilities


  1. Reviews and screens initial and renewal credentialing and privileging applications for completeness, accuracy, and compliance with Health Resources and Services Administration (HRSA), Federal Tort Claims Act (FTCA) federal, state, and local regulations, guidelines, policies, and standards.
  2. Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing and privileging elements; assesses completeness of information and qualifications relative to credentialing and privileging standards, policies and procedures.
  3. Serves as the staffs point of contact for the credentialing & privileging process, communicates the status of all applications to management, and accurately maintains tracking spreadsheets.
  4. Maintains all staff documentation of compliance with BLS certification and immunization requirements as per local, state, and federal requirements (FTCA).
  5. Maintains credentialing and privileging files on all clinical staff and ensures timely re-credentialing and privileging in adherence to HRSA, FTCA and policy requirements.
  6. Coordinates Credentialing and Privileging Committee meetings and presents credentialing and privileging file to the committee to assist in the approval or denial process.
  7. Coordinates with Billing Department to ensure timely clinician enrollment into CAQH and maintenance of CAQH clinician profiles.
  8. Other duties as assigned.

Education/Certifications/Licensure


Required


  • Must have an associate degree. Preferred: Bachelor's degree.
  • Must have a valid drivers license and be able to pass a pre-employment physical

Skills


Required


  • Must have computer and Microsoft suite skills
Preferred


  • Bilingual ability (English/Spanish)


Physical Requirements
If a preliminary offer of employment is extended, a physical will be required before the offer can be accepted.

Light to medium physical duties include standing, walking, reaching, bending, talking for up to eight (8) hours a day. Must have good vision. Must be able to lift thirty-five pounds. Lifting will be primarily confined to occasional on premises lifting of boxes of office supplies and minor office equipment. Non-physical demands include performing multiple tasks simultaneously, the ability to meet multiple deadlines, judgement decisions and working closely with others as part of a team.