Credentialing Specialist

2 months ago

Lafayette, United States Clinica Family Health Full time
What we offer:

Benefits:

  • Medical
  • Dental
  • Vision
  • FSAs/HSAs
  • Accident/Hospital
  • Retirement Plan
  • + other Employee & Family Support Programs
Other Perks: Flexible Schedules, 4 weeks of PTO, Paid Holidays, Growth Opportunities/Career Ladders
Compensation:Approximately $21.20 - $25.31 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity.

Overview of Role:

*This is an ONSITE position located in Lafayette, CO.*

Administer the credentialing and privileging process for all independent licensed providers and other licensed and certified practitioners. Facilitate the process in collaboration with the Credentialing Supervisor, Chief Medical Officer, Chief Dental Officer, Chief of Integrated Services, providers, Clinic Medical/Dental Directors and Vice President of Behavioral Health.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Performs primary source verification of credentials healthcare providers and clinical staff to ensure that all necessary licenses and credentials are valid and updated. This includes contacting licensing boards, reviewing license applications, obtaining education information, reviewing references and other information, as needed and/or required in accordance with federal regulations.
  • Contacts new providers and practitioners to explain the credentialing and privileging process and procure required documentation.
  • Initiate the credentialing and privileging process within a time frame that will ensure the provider will have temporary privileges prior to seeing patients. In almost all cases this will be prior to hire date.
  • Facilitate initial hospital credentialing and privileging process for providers who will have hospital privileges. Develop and maintain productive relationships with counterparts at these hospitals.
  • Facilitate the privileging process by ensuring that all required forms are completed, and the requested privileges are proctored in a timely manner.
  • Monitor and notify providers/practitioners and their managers of upcoming licensure, certification, training and privileges expirations.
  • Communicate and follow up with all parties to move the credentialing, privileging and re-credentialing processes forward.
  • Engage the appropriate manager, CMD or Chief Officer when important documentation that will impede the credentialing process is not received in a timely manner.
  • Prepare records for auditing, both internal and external, as needed. Participate in the auditing process.
  • Enroll providers in Medicare, Medicaid, CHP+ and selected private insurances. Follow up with insurers in a regular and timely manner to obtain effective dates and to re-credential, as needed. Maintain required portal accounts for government and private insurance enrollment.
  • Monitor and maintain CAQH accounts for licensed billable providers.
  • Maintain databases to track licensing, compliance with federal standards, completion of necessary training and education and continuing education completion.
  • Maintain organizational spreadsheets and databases used to track credentials, licensing, insurance and privileging information.
  • Provide input on policy changes that impact the credentialing and privileging process. Stay current on laws and regulations related to the credentialing and privileging process.
  • Provide input and data for the FTCA deeming process and the UDS reporting process, as needed.
  • Cooperate and comply with all regulatory, accrediting, and membership-based organizations as is required to complete the credentialing process.
  • Create and maintain electronic credentialing files for all providers and practitioners.
  • Facilitate onboarding process for student proctoring rotations.
  • Assist providers receiving loan reimbursement with required information and data for biannual reporting


POSITION QUALIFICATIONS:

Education / Experience

  1. High School graduate or GED. Post-secondary education preferred.
  2. Three years of experience with credentialing and privileging in an FQHC preferred.
  3. Certified Provider Credentialing Specialist (CPCS) certification preferred.
Knowledge, skills and abilities:
  1. Strong Communication skills
  2. Exceptional organizational skills and attention to detail.
  3. Ability to professionally and positively interact with individuals at all levels of the organization.
  4. Tenacity in adhering to policies while pushing forward to complete processes.
  5. A commitment to staying on top of processes and reporting out on progress.
  6. Ability to use diplomacy and professionalism to firmly gain cooperation from individuals without creating animosity.
  7. Ability to grasp personal ownership and accountability in the process of credentialing.
  8. Respect confidentiality of processes and information that is handled daily.


Clinica Family Health is an Equal Opportunity Employer. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, color, religion, national origin, sex, disability, sexual orientation, gender identity, or any other applicable status protected by federal, state, or local laws.

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