Job Overview
Responsible for the credentialing, privileging, licensing of all providers in accordance with established regulatory and policy requirements. This is a highly confidential position and due care is required to secure confidential information. Responsible for the timely completion and submission of required documentation for each required entity including hospitals, state and federal licensures and health plans.
Job Duties
· Initiates and coordinates the acquisition and receipt of all credentialing documentation from new and existing providers; provides follow-up and problem resolution as required.
· Coordinates processing and distribution by sending correct and complete documentation for each participating provider or healthcare professional to the appropriate hospitals, licensing boards and insurance companies (including subcontracted entities) in a timely manner and follows up on status of process.
· Maintains and ensures strict confidentiality of files and databases.
· Provides medical staff offices and insurance companies with everything needed to complete the credentialing process efficiently and effectively. Acts as a liaison between the provider being credentialed and agency completing the credentialing to ensure timeliness of credentialing process.
· Reviews provider directories supplied by the insurance companies to ensure all provider listings are complete and correct. Notifies, in writing, insurance company of any necessary corrections and follows up to ensure corrections are made.
· Notifies appropriate entities when providers leave the company to ensure that the names and affiliation are removed from the company listing or contract.
· Maintains good consistent oral and written communication and works to establish and maintain good business relationships with insurance companies, regulatory agencies, medical staff, office personnel, clinic managers, providers, other FirstMed staff and government agencies.
· Maintains and distributes regular written updates on the credentialing process including, but not limited to, insurance contracts by provider list and contracted insurance grid to
appropriate personnel, including but not limited to, administrators, department chairs, billing and FirstMed administration.
· Management of computerized credentialing software database.
Qualifications:
· High School Diploma
· Associate degree and/or higher
· Knowledge of medical provider credentialing and accreditation principles, processes, procedures, regulations, standards, state licensing requirements and documentation
· Working knowledge of provider specialties and service delivery
· Working knowledge of local third-party payors and insurance companies
· Ability to handle multiple tasks as well as the ability to prioritize those tasks
· Demonstrated ability to read, write, and speak English at a professional level.
· Ability to write reports and general business correspondence
· Possess strong knowledge of state, federal and local regulatory bodies and/or guidelines for credentialing
· Working knowledge of computers and other general office machines (i.e. fax machine, copy machine, scanning etc.)
· Working knowledge of credentialing software, database management, spreadsheets, word processing, and email
· Advanced knowledge of Microsoft Excel, Word, and Outlook
· Ability to cross-train others when needed to ensure continuation of credentialing process
· Ability to evaluate and recognize areas for process improvement and/or implement new procedures
· Demonstrated strong problem-solving skills and the ability to plan and complete assigned projects
· Ability to maintain confidentiality and follow regulatory guidelines
· Brings sensitive and confidential issues to the attention of the Credentialing Manger and/or the CFO.
· Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
· Ability to work with providers and others in a highly professional manner and maintain good working relationships
· Strong organizational and time management skills
· High demands for accuracy, ability to meet deadlines, adhere to complex and constantly changing regulations along with the pressure of managing multiple priorities.
Experience
· A minimum of (3) three years’ experience of credentialing in healthcare including medical, dental and behavioral health
· Must have knowledge, experience and understanding of working with FQHC’s.
Pay: From $25.00 per hour
Benefits:
- 403(b)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Education:
- High school or equivalent (Preferred)
Experience:
- MCO Credentialing: 3 years (Required)
- Medical provider credentialing & accreditation: 3 years (Required)
Work Location: In person
