- Compiles and maintains current and accurate data for all providers.
- Completes provider credentialing and re-credentialing applications of SCHC providers to address SCHC obligations with outside agencies; monitors applications and follows-up as needed.
- Tracks license, DEA and professional licensing expirations for appointed SCHC providers; tracks professional liability for specially contracted providers if not covered under SCHC’s FTCA coverage and gap coverage
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Sets up and maintains provider information in online credentialing databases and system.
- Tracks license and certification expirations for all clinical staff to ensure timely renewals.
- Ensures practice addresses are current with health plans, agencies and other entities.
- Processes applications for appointment and reappointment of privileges to SCHC.
- Maintains SCHC appointment files, and information in credentialing database.
- Audits health plan directories for current and accurate provider information.
- Assists in processing care application for providers
- Identify problems with current systems, policies and procedures to ensure compliance with BPHR and HRSA Compliance Manual, other related laws and regulations, and best practices.
o Anticipate issues with current system to avoid any non- compliance.
o Assess problems and report to management team.
o Propose potential solutions and changes.
o Establish changes to systems.
o Establish training/ communications for changes to keep management team and impacted staff.
- Create and maintain required documentation for OPPE.
- Support and enforce compliance with credentialing and privileging requirements by SCHC staff in coordination with the Human Resources, Medical Staff Office Manager, and other Senior Management officers.
- Produce and analyze monthly exclusions checks and related reports for SCHC employees, contracted providers and board members.
- Develops materials for credentialing and privileging reviews.
- Coordinates and facilitates credentialing committee reviews and actions.
- Coordinates with Senior Clinical Recruiter and Medical Staff Office to assess and address credentialing and privileging needs of new staff.
- Understands and adheres to the Ethics, Compliance and Code of Conduct policy.
Additional Responsibilities
- Maintains confidentiality of provider information.
- Provides credentialing and privileging verifications.
- Performs other duties as assigned.
- Knowledge and understanding of the credentialing process.
- Strong communication skills.
- Ability to organize and prioritize work and manage multiple priorities.
- Excellent verbal and written communication skills including letters, memos and emails.
- Ability to read, write, understand and spell English and medical terminology correctly.
- Excellent people skills and customer service orientation.
- Excellent attention to detail.
- Ability to research and analyze data.
- Ability to work independently with minimal supervision.
- Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
- Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
- Associate degree or equivalent training and/or experience
