Human Resources Specialist

2 weeks ago

Winter Haven, United States Central Florida Health Care Full time
Title: Human Resources Specialist - Credentialing

Reports to: Regional Human Resources Manager

FLSA Status: Non-Exempt
Personnel Supervised: None

POSITION SUMMARY:

The Credentialing Specialist works with all clinical member staff and external sources to ensure compliance with CFHC Credentialing and Human Resources Policies, JC, HRSA and FTCA standards and guidelines and other applicable federal, state and local regulatory and/or accrediting agencies. The Credentialing Specialist is responsible to facilitate all aspects of credentialing, including Initial appointment, reappointment, monitoring, privileging for all LIP, OLCP and OCS. This position supports the general business operations of CFHC and its customers.

MINIMAL QUALIFICATIONS:
  • Associates Degree in information technology, Human Resources Management, Business Administration, or 2 years of HR administrative experience required.
  • Attention to detail and problem-solving competencies
  • Strong analytical, problem solving, organizational, interpersonal, and communication skills required.
  • Expert proficiency in Microsoft suite of products (Outlook, Word, PowerPoint, and Excel).
  • Able to perform in a fast-paced environment while always maintaining excellent service.
  • Ability to handle sensitive information in a confidential manner.
  • Ability to work independently
RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
  • Maintains current knowledge of JC, HRSA, FTCA clinical staff credentialing standards and state and federal requirements
  • Reviews and maintains the confidentiality of information and materials that may include sensitive or adverse information
  • Leads and participates in credentialing projects, researching regulatory and industry standards to identify approaches to new or existing project implementation, and presenting research and recommendations to the RHRM
  • Provides and implements recommendations for process and procedure workflow changes
  • Researches and analyzes complex credentialing issues and develops and proposes solutions
  • Main contact between Managed Care and Credentialing for providers AHCA backgrounds (initial and renewals)
  • Facilitates Credentialing session during on-boarding with new hires
  • Manages all aspects of the Credentialing function; defines and implements processes ensuring HRSA compliance and audit ready preparedness
  • Manages all aspects of the Credentialing function and Credentialing Software
  • Organize and maintain file systems, credentialing files, correspondence, and other records
  • Maintain National Practitioner Database for administrative purposes including active employee database
  • Responsible for Verify Comply OIG verifications. The SAM's government report for all current employee's
  • Proactively formulate ideas and recommendations for system improvements
  • Conducts provider credentialing and re-credentialing, including performing Primary Source Verifications
  • Responsible for all verified information and prepares credentialing files
  • Disseminate information to other CFHC departments as required and maintains RegLantern w/required documents
  • Coordinates providers and clinical staff training and access to "RegLantern"
  • Compile, prepare, copy and distribute correspondence, memorandums to obtain information from a variety of sources
  • Assists with the credentialing / background process by communicating with new hires to get all needed HRSA and Joint Commission required credentialing and Privileging paperwork
  • Responsible for initial AHCA backgrounds and fingerprints for LIP's, Sr. Leaders, Board Members, and etc.
  • Performs ongoing monitoring of license status and state and federal sanctions of contracted and non-contracted providers and all clinical staff
  • Sets up and maintains provider information in online credentialing databases and RegLantern the electronic credentialing system
  • Maintain accurate and up to date credentialing provider files
  • Research colleges and Universities for verification of Educations
  • Manage and send out the 90-day competencies
  • Manage and send out the bi-annual competencies for all clinical staff
  • Run OIG report on all new employees and on all re-credentialed employees
  • Send daily credentialing communications to employee as needed
  • Prepare and Maintaining records of credentialing activities such as accreditation, membership and privileges
  • Responsible for the overall Credentialing and Privileging Committee meetings including presenting new hires, recredentialed employees, and meeting minutes.
  • Responsible for all requests for additions/deletions of privileges and/or changes in staff status and process through the Credentialing and Privileging committees
  • Utilize DocuSign for credentialing where possible
  • Edit credentialing and privileging forms and upload to HR Drive and DocuSign including checklist, privileging, health attestation and job descriptions
  • Create credentialing files for all new hires
  • Remove all terminated employee files from cabinets and Reglantern credentialing software program
  • Review for accuracy the AssureHire and Labcorp monthly invoices
  • Participate in projects and other duties as assigned
PHYSICAL REQUIREMENTS:
  • Standing/walking/sitting for long periods.
  • Routinely operate standard office equipment to include but not limited to computers, phones, photocopiers, filing cabinets, and badge printer
  • Independently mobile
  • Ability to adapt and function in varying environments of workload, worksites, and work shifts.


American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.

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