Healthcare Credentialing Expert

6 days ago

Oneonta, United States A.O. Fox Full time

What We Offer:

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A.O. Fox is committed to creating a positive and inclusive work environment that fosters growth and development for our employees. We offer a competitive compensation package, comprehensive benefits, and opportunities for advancement.

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Your Role:

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This role involves providing diversified, high-quality, and confidential credentialing services, including leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. You will work independently under the general supervision of the Manager of Medical Staff Affairs (MSA).

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Responsibilities:

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  • Process initial and reappointment applications within three days of receipt from applicant with 95-100% accuracy as observed by the manager.
  • Accurately enter practitioner information into the credentialing database within three days of receipt with 95-100% accuracy as observed by the manager.
  • Perform primary source verification on all practitioners, which includes sending letters to verify licensure, board certification, education, internship, residency, fellowship, references, NPDB, Medicare/Medicaid sanctions, etc. within the 12-week time frame according to the Medical Staff Policy and Procedures as observed by the manager.
  • Identify red flags, and items requiring further review/additional information and bring them forth to the MSA Manager, Clinical Chief, and the Medical Staff President.
  • Ensure compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
  • Process requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
  • Maintain confidentiality of all credentialing information as noted in the Medical Staff Policy and Procedure Manual and as observed by the manager.
  • Assemble all credentialing packets for presentation to the Credentials Committee of the Medical Staff.
  • Serve as a resource to practitioners and clinical chiefs with issues regarding licensing, board certifications, and anything else that would encompass credentialing as observed by the clinical chief and reviewed by the credentialing and department manager.
  • Communicate regularly with the practitioner and Clinical Chief regarding the credentialing status.
  • Conduct regular internal audits of the credentialing files to ensure compliance with regulatory agencies, Medical Staff Policies and Procedures, and Bylaws.
  • Responsible for the accuracy and integrity of the credentialing database system and related applications.
  • Maintain an accurate and up-to-date record of internal and external CMEs in the providers file.
  • Respond to data requests Coordinate all new provider orientation schedules after approval by the Board of Trustees.
  • Respond to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
  • Respond weekly to affiliation/employment verification requests for all APCs and Medical Staff.
  • Work collaboratively with the affiliate hospital Medical Staff Offices Attends meetings as assigned and prepares minutes as requested.
  • Presents a positive image of A.O. Fox through professional appearance and behavior as observed by supervisor and feedback from customers.
  • Communicates effectively to ensure vital operational information is shared among co-workers.
  • Exercises independent judgment within the scope of responsibilities and absence of direct authority.
  • Attends all required hospital education programs.
  • Performs other duties as requested and observed by manager.
  • Accepts special projects and completes by the designated deadline.
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Requirements:

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We are seeking a highly skilled and detail-oriented individual with a strong background in administrative support or business office experience. A minimum of 1 year of experience is required, with a preference for those with an Associate degree. Additionally, candidates should possess excellent communication and customer service skills, as well as proficiency in computer software and applications.

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Benefits:

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A.O. Fox offers a comprehensive benefits package, including paid time off, medical, dental, and vision insurance, life insurance, disability protection, and retirement benefits, including an employer match.

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Compensation:

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The salary range for this position is $20.29 - $30.44 per hour, based on qualifications, experience, and education.

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