Provider Credentialing
1 month ago
Coordinates the transition of all relevant provider credentials, licenses, degrees, privileges, and certifications upon signing of a new provider. Operational ownership of the centralized credentialing process includes interfacing with new provider (Physicians & APPs), gathering paperwork from CVO or other institutional governance body, coordinating all relevant documents, authorizations, and credentials for submission processes. This role partners and work closely with department leadership, leaders throughout the system and other facilities including Departmental Leaders, Recruitment, Onboarding, Medical Staff Affairs, Hospital Medical Directors, Community Office Managers, HPN, and various State Board entities.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE:
1. Associates Degree
OR
High School Diploma or Equivalent AND 2 years of healthcare or administrative experience
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. One year of Experience with privileging/credentialing.
2. One year of Experience in a healthcare setting.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Facilitates the credentialing process for all incoming doctors and APPs: Applies for state licensure, creates needed agreements, applies for drug dispensing licenses, completes multiple forms and packets, coordinates with outside facilities, training institutions and device companies for privilege specific documentation including international institutions, interacts with references, facilitates interactions between the physician and onboarding team, and acts as the liaison between medical staff affairs/provider enrollment and incoming providers.
2. APP Specific Support: Sets up and coordinates practice and collaborative agreements, monthly meeting minutes for weekly calls, and scheduling. Functions as the APP payroll representative and assists the Manager/Director with APP time off requests, meetings, other clerical functions as needed, including but not limited to obtaining parking passes, ordering scrubs, EPIC set-up, CLB and NetLearning assistance, adding APPs to distribution lists, and email account set up.
3. Coordinates the completion of reappointment packets with providers, including building complex reports from multiple data sources to validate volume requirements.
4. Tracks state licenses, board certifications, and needed training/educational certifications- collaborating with the physician for all initial and renewal requirements to ensure compliance and maintains up to date records for each provider.
5. Manages all provider evaluations- FPPE and OPPE (Quarterly and Yearly)- runs volume logs, coordinates multi-department signatures, obtains med staff approval, and maintains complete records while also distributing to needed partners.
6. Coordinates with Health Partners Network (HPN) for payor enrollment to make sure all providers are enrolled with necessary payors.
7. Monitors the state boards websites for changes and upcoming events and corresponds with leadership about provider matters.
8. Ensure maintenance of CME records and update of transcripts regularly.
9. Maintains working knowledge of JCAHO standards, NCQA standards, URAQ standards, the State Medical Board, and other regulatory agencies particularly with reference to accreditation and quality improvement. Implements the appointment and reappointment process for all of the department faculty and APPS.
10. Manages and maintains an organized, systematic online data base, to record credentialing statistics, and key information that is utilized in multipurpose functions across department and our key stakeholders.
11. Implement and maintain data, statistical and demographic, used to generate accurate medical staff profiles, quality improvement indicators, hospital-specific delineated privilege forms, etc. on an on-going basis. Implement and maintain credentialing software.
12 Processes day-to-day WVUHS Insurance Provider Enrollment requests within the scope of contractual agreements.
13. Maintains updated individual staff profiles, reporting all changes to WVUHS Insurance Provider Enrollment as contracted.
14. Presents provider credentialing and onboarding status report in designated departmental meetings. Immediately alerts department leadership of potential delays or barriers to providers' onboarding date. Ensures required documentation is received and saved to provider personnel files. Completes and submits new hire documents based on individual department's procedures.
15. Assists in project work as identified by departmental needs.
16. The department maintains clinic schedules and facility affiliations with multiple locations and across multiple state lines- this position requires the candidate to Establish and maintain engagement with new faculty members from date of signed offer letter through hire date and every two years for recredentialing at each site the provider has privileges.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Prolonged periods of sitting.
2. Ability to lift 15-20 lbs.
3. Extended periods of computer and telephone usage.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Normal office environment.
2. May require Travel.
SKILLS AND ABILITIES:
1. Must possess basic computer knowledge and ability to operate standard office software.
2. Must possess strong oral and written communication skills.
3. Must have the ability to maintain high standards of confidentiality.
4. Must have strong organizational skills.
5. Ability to type at least 35 wpm preferred.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)
Exempt/Non-Exempt:
United States of America (Non-Exempt)
Company:
SMG System Medical Group
Cost Center:
671 SMG Corporate Admin
Address:
WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.
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