Credentialing Specialist

3 weeks ago

Reisterstown, Maryland, United States LADGOV CORPORATION Full time
Credentialing Coordinator Job Description

About the Role:

We are seeking a highly organized and detail-oriented Credentialing Coordinator to join our team at LADGOV CORPORATION. As a Credentialing Coordinator, you will be responsible for organizing, maintaining, and verifying all aspects of the credentialing process for healthcare practitioners in a healthcare-related facility.

Key Responsibilities:
  • Responsible for organizing, maintaining, and verifying all aspects of the credentialing process for healthcare practitioners.
  • Responsible for answering inquiries regarding providers' credential status and working with colleagues to ensure the accuracy of all files by tracking the expiration of licenses and certifications.
  • Responsible for ensuring that all providers' military medical credentialing and privileging is initiated, maintained, and transferred as required, throughout the term of their military service.
  • Responsible for contacting military medical staff, commanders, Readiness NCOs, the National Guard Bureau, and the Office of the State Surgeon and its representatives, as well as communicating with outside healthcare facilities to maintain up-to-date files on physicians, dentists, physician assistants, nurse practitioners, nurses, psychologists, and social workers.
  • Perform all aspects of military provider credentialing and privileging of all assigned providers.
  • Collect all required legal documentation for each provider to be credentialed, including medical diploma, DEA license, state license, National Practitioner Database records, malpractice documentation, certifications, post-graduate training records, and references in accordance with HIPAA guidelines.
  • Validate the accuracy and completeness of all records received. Ensure all new initial provider applications are complete, and initiate their credentialing and privileging.
  • Maintain custody of all credentialing materials via the Centralized Credentials Quality Assurance System (CCQAS).
  • Upload records to build and maintain provider profiles, including demographic information, educational documentation, continuing education credits, intra-facility credentialing transfer briefs (ICTBs), custody transfers, and adverse action reports.
  • Track document expiration status in CCQAS and ensure records are updated in a timely manner.
  • Using validated credentialing materials, build comprehensive credentialing packets and ensure their absolute integrity for submission to the Centralized Credentialing and Privileging Board (CCPB).
  • Attend CCPB meetings and present credentialing packets to the Board for approval.
  • Utilize validated credentialing materials to create state privileging packets for approval by State Surgeon.
  • Build ICTBs as required for all providers attending Annual Training or mobilizing outside of Maryland.
  • Validate document currency for all records in the ICTBs prior to submission.
  • Follow-up on all ICTB submissions to ensure their completion and transfer to the gaining facility.
  • Routinely collaborate with all MDARNG providers, Centralized Credentialing personnel, and the National Guard Bureau Office of the Chief Surgeon staff to ensure all requirements are being met and identify process changes.
  • Receive medical documentation and maintain HIPAA compliance throughout routing to the appropriate personnel.
Requirements:

Education & Qualifications:
  • Shall have a minimum of two years practical experience in provider credentialing and privileging, including receiving and compiling medical provider legal documentation, building comprehensive credentialing packets, and ensuring their absolute integrity.
  • Experience and knowledge of Army and National Guard Bureau regulations and policies relating to provider credentialing and privileging, and utilizing the Defense Health Agency's Centralized Credentials Quality Assurance System (CCQAS), are preferred.

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