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HHA Credentialing Specialist

2 months ago

Cambridge, United States Bryan Health 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.