Job Summary
Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers through the evaluation, analysis, and coordination all aspects of the credentialing and recredentialing processes for practitioners practicing within the WesternU Health System clinical entities.
Knowledge, Skills and Abilities
Individuals must possess the knowledge, as well as the following skills and abilities or be able to perform the essential functions of the job, with or without reasonable accommodation using some other combination of skills and abilities.
· Strong working knowledge of healthcare provider credentialing process
· Experience working with Windows based applications: Excel, Word, Outlook, SharePoint
· Significant knowledge of State and Federal Regulatory requirements and accreditation standards, e.g., NCQA, NPDB, Title XXII, CAQH and NPPES related to healthcare provider credentialing
· Considerable working knowledge of credentialing management applications, e.g., Verity Stream
· Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization, and computer skills
· Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
· Demonstrated attention to detail and good organizational capability.
· Able to handle multiple simultaneous tasks and complete work projects in designed time frames.
Required Qualifications
Any combination, training or experience that provides the required knowledge, skills, and abilities.
Experience: Two years of relevant experience in provider credentialing.
Education: High School Diploma or equivalent.
Preferred Qualifications
Preference will be given to individuals with NAMSS Certification as Certified Provider Credentialing Specialist (CPCS) certification. A background in clinical academic setting is highly preferred.
Essential Job Duties
1. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
2. Prepares documents for primary source verification process, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and WesternU Health System criteria.
3. Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other peculiarities that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Executive Director University Compliance and Chair of Provider Credentialing Committee for sound decision making in accordance with credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
4. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
5. Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy, and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
6. Submits and responds to requests for required documentation to third-party payors for credentialing/recredentialing.
7. Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
8. Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
9. Communicates clearly with providers, their liaisons, Clinical Deans and WesternU Health Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
10. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
11. Performs miscellaneous job-related duties as assigned.
Job Type: Full-time
Pay: $25.00 - $28.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Tuition reimbursement
- Vision insurance
Experience:
- Microsoft Office: 1 year (Preferred)
- Medical Credentialing Occupations: 1 year (Preferred)
- Microsoft Word: 1 year (Preferred)
Work Location: In person
