HHA Credentialing Specialist

2 weeks ago

Cambridge, United States BryanLGH Medical Center Full time

SUMMARY: # The HHA Credentialing Specialist ensures that practitioner credentialing files are completed and returned to Heartland Health Alliance (HHA) clients in a timely and accurate manner. # RESPONSIBILITES INCLUDE BUT ARE NOT LIMITED TO: # *Commits to the mission, vision, beliefs and consistently demonstrates our core values. *Facilitates practitioner packets for appointment and reappointment. *Coordinates procurement of Drug Enforcement Administration (DEA) information, licensure and malpractice insurance information. *Provides practitioners with appropriate delineation of privilege forms. *Completes primary source verification on practitioner applications. *Ensures that all practitioner credentialing files are completed and submitted back to the client within 30 business days of receipt of the completed application and supporting documents. *Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references). *Prepares credentialing files for clients. *Provides phone coverage for the Heartland Health Alliance office; relays messages in a timely fashion and provides information to callers as appropriate. *Identifies and notates the practitioner file with any potential red flag findings in the verification process. *Sorts and routes incoming departmental mail; delivers out-going department mail. *Maintains departmental files including processing file revisions. *Performs copying, faxing, printing and distribution of information. *Proactively requests upcoming expirable items and communicate with the client to ensure that the file is kept current (i.e. State License, DEA License and Malpractice Insurances).# *Maintains information on sanctions and insurance liability claims. *Provides quality assurance audit for each practitioner file prior to file release to the client.*Utilizes# relevant software to produce communication; sets up databases and tracks regulation compliance #*Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs. QUALIFICATIONS: # High school diploma or equivalent required.# Prior medical office experience required. # #

SUMMARY:

The HHA Credentialing Specialist ensures that practitioner credentialing files are completed and returned to Heartland Health Alliance (HHA) clients in a timely and accurate manner.

RESPONSIBILITES INCLUDE BUT ARE NOT LIMITED TO:

* Commits to the mission, vision, beliefs and consistently demonstrates our core values.
* Facilitates practitioner packets for appointment and reappointment.
* Coordinates procurement of Drug Enforcement Administration (DEA) information, licensure and malpractice insurance information.
* Provides practitioners with appropriate delineation of privilege forms.
* Completes primary source verification on practitioner applications.
* Ensures that all practitioner credentialing files are completed and submitted back to the client within 30 business days of receipt of the completed application and supporting documents.
* Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references).
* Prepares credentialing files for clients.
* Provides phone coverage for the Heartland Health Alliance office; relays messages in a timely fashion and provides information to callers as appropriate.
* Identifies and notates the practitioner file with any potential red flag findings in the verification process.
* Sorts and routes incoming departmental mail; delivers out-going department mail.
* Maintains departmental files including processing file revisions.
* Performs copying, faxing, printing and distribution of information.
* Proactively requests upcoming expirable items and communicate with the client to ensure that the file is kept current (i.e. State License, DEA License and Malpractice Insurances).
* Maintains information on sanctions and insurance liability claims.
* Provides quality assurance audit for each practitioner file prior to file release to the client.*Utilizes relevant software to produce communication; sets up databases and tracks regulation compliance
* Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs.

QUALIFICATIONS:

High school diploma or equivalent required. Prior medical office experience required.

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