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Credentialing Specialist

1 month ago

Oneonta, United States A.O. Fox Full time

Overview:

Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible.

Responsibilities:

Under the general supervision of the Manager of Medical Staff Affairs (MSA), the Specialist works independently in cooperation with the MSA Manager, Physician Recruiters, Clinical Chiefs, and other personnel to provide diversified, high quality, and confidential credentialing services. The Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

  • Processes initial and reappointment applications within three days of receipt from applicant with 95-100% accuracy as observed by the manager.
  • Accurately enters practitioner information into the credentialing database within three days of receipt with 95-100% accuracy as observed by the manager.
  • Performs primary source verification on all practitioners, which includes sending letters to verify licensure, board certification, education, internship, residency, fellowship, references, NPDB, Medicare/Medicaid sanctions, etc. within the 12 week time frame according to the Medical Staff Policy and Procedures as observed by the manager.
  • Identifies red flags, and items requiring further review/additional information and brings them forth to the MSA Manager, Clinical Chief and the Medical Staff President.
  • Ensures compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
  • Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
  • Maintain confidentiality of all credentialing information as noted in the Medical Staff Policy and Procedure Manual and as observed by the manager.
  • Assembles all credentialing packets for presentation to the Credentials Committee of the Medical Staff.
  • Serve as a resource to practitioners and clinical chiefs with issues regarding licensing, board certifications, and anything else that would encompass credentialing as observed by the clinical chief and reviewed by the credentialing and department manager.
  • Communicate regularly with the practitioner and Clinical Chief regarding the credentialing status
  • Conduct regular internal audits of the credentialing files to ensure compliance with regulatory agencies, Medical Staff Policies and Procedures and Bylaws.
  • Responsible for the accuracy and integrity of the credentialing database system and related applications
  • Maintains an accurate and up-to-date record of internal and external CMEs in the providers file
  • Responds to data requests Coordinates all new provider orientation schedules after approval by the Board of Trustees
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
  • Responds weekly to affiliation/employment verification requests for all APCs and Medical Staff
  • Work collaboratively with the affiliate hospital Medical Staff Offices Attends meetings as assigned and prepares minutes as requested
  • Presents a positive image of Bassett Healthcare Network through professional appearance and behavior as observed by supervisor and feedback from customers.
  • Communicates effectively to ensure vital operational information is shared among co-workers
  • Exercises independent judgment within the scope of responsibilities and absence of direct authority
  • Attends all required hospital education programs
  • Performs other duties as requested and observed by manager.
  • Accepts, special projects and completes by the designated


Qualifications:

Education:

  • High School Diploma or equivalent, required
  • 2 Year / Associate degree, preferred

Experience:

  • Minimum 1 year administrative support or business office experience, required
  • Minimum 1 year experience with extensive public contact and customer service, required

Licensure/Certifications:

  • CPCS Certified Provider Credentialing Specialist, preferred

Skills:

  • Organizing/Categorizing records
  • Communication
  • Attention to Detail
  • Analysis & Evaluation
  • Computer Skills
  • Maintain Confidentiality
  • Reading/Writing/Comprehension
  • Build Relationships
  • Time Management
  • Self-Motivated

Physical Requirements:

  • Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking or standing are required only occasionally, and all other sedentary criteria are met
  • Occasional lifting, pulling, pushing, reaching, standing, stooping, walking
  • Constant typing/clerical/dexterity, grasping, hearing, repetitive motion, seeing/monitor/computer use, talking, visual acuity

Travel:

  • Occasional Travel - The job may require travel from time- to-time, but not on a regular basis


Total Rewards:

Bassett Healthcare Networks commitment to our employees includes benefit programs carefully designed with the needs and values of all our employees in mind. Many of the benefits we offer are paid fully or in large part by Bassett. Our generous benefits offerings include:

  • Paid time off, including company holidays, vacation, and sick time
  • Medical, dental and vision insurance
  • Life insurance and disability protection
  • Retirement benefits including an employer match
  • And more

Specific benefit offerings may vary by location and/or position.

Pay Transparency Statement (Text Only):
Salary is based on a variety of factors, including, but not limited to, qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards. The above compensation range represents a good faith belief of the compensation range by Bassett Healthcare Network, and its entities and affiliates, at the time of this posting or advertisement.

Min:
USD $20.29/Hr.

Max:
USD $30.44/Hr.

EEO Statement (Text Only):
We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.