Credentialing Specialist

3 days ago

Chardon, United States University Hospitals Full time
A Brief Overview
Manage all aspects of UH Provider and Central Verification Organization (UH PCVO) credentialing and recredentialing verification process for assigned clients to meet standards and requirements of client, UH PCVO, National Committee for Quality Assurance (NCQA), Joint Commission (JC), Utilization Review Accreditation Commission (URAC), Centers for Medicare and Medicaid Services (CMS), federal and state, and other regulatory or accreditation bodies.
What You Will Do
  • Collects and analyzes verification information and documents in accordance with accreditation standards noted above for the system-wide initial and reappointment programs.
  • Records data into the enterprise credentialing software in a timely and accurate manner so that provider information is available to all downstream system feeds including the provider lookups on the internet, intranet, and Soarian etc.
  • Performs ongoing monitoring and auditing of required credentials including Ohio license, DEA registration(s), malpractice insurance, board certification (s), CPR certification(s), and Visa/Permanent Resident status in accordance with all applicable regulatory standards.
  • Researches high volume of referring providers to establish identity so that all downstream systems have the same data.
  • Independently prioritizes assignments including continual special projects to ensure timely completion of work that meets strict accrediting body timelines.
  • Performs an integral role in system-wide reappointment process.
  • Collaborates with Medical Staff Coordinators to complete credentials file.
  • Serves as content expert and participates in onboarding and training of new team members
  • Supports the medical staff with credentialing related projects as assigned
  • Collecting practitioner dues, maintaining on-call schedules and meeting management.
Additional Responsibilities
  • Performs other duties as assigned.
  • Complies with all policies and standards.
  • For specific duties and responsibilities, refer to documentation provided by the department during orientation.
  • Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.


Qualifications:
Education
  • Associate's Degree (Required) and
  • Bachelor's Degree (Preferred)
Work Experience
  • 3+ years experience in an administrative or healthcare field (Required) and
  • Medical staff or managed care credentialing experience (Required) and
  • experience with functions performed in a Centralized Verification Organization strongly (Preferred) and
  • Experience with regulatory standards (e.g., NCQA), and records management (Preferred) and
  • Excellent computer skills, including Microsoft Word, Access, and Excel Experience with Adobe Acrobat Professional and credentialing software (Preferred)
Knowledge, Skills, & Abilities
  • Strong analytical skills and excellent written and oral communication skills, including editing and proofreading, to ensure high quality of communication, documentation, and published information. (Required proficiency)
  • The qualified applicant must possess strong interpersonal skills, teamwork, and ability to communicate effectively with all levels of staff, physicians, leadership, and internal/external customers. (Required proficiency)
  • Maintenance of confidentiality essential. (Required proficiency)
  • Demonstrated superior organization skills, priority setting, accomplish work independently and reliably, and multi-task management. (Required proficiency)
Licenses and Certifications
  • Current NAMSS CPCS certification (Preferred)
Physical Demands
  • Standing Occasionally
  • Walking Occasionally
  • Sitting Constantly
  • Lifting Rarely 20 lbs
  • Carrying Rarely 20 lbs
  • Pushing Rarely 20 lbs
  • Pulling Rarely 20 lbs
  • Climbing Rarely 20 lbs
  • Balancing Rarely
  • Stooping Rarely
  • Kneeling Rarely
  • Crouching Rarely
  • Crawling Rarely
  • Reaching Rarely
  • Handling Occasionally
  • Grasping Occasionally
  • Feeling Rarely
  • Talking Constantly
  • Hearing Constantly
  • Repetitive Motions Frequently
  • Eye/Hand/Foot Coordination Frequently
Travel Requirements
  • 10%

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