Credentialing Specialist Expedited Processing in Houston, TX at Parallon

Date Posted: 8/1/2018

Job Snapshot

Job Description

JOB SUMMARY
This position will be responsible for supporting the development and implementation of the Credentialing Processing Center policy and procedures.  This will include, but not be limited to responsibility to analyze and act upon credentialing data and images of new and established health care providers, as well as maintenance of information to include primary source verification, follow- up, data collection, data entry, and document review.  Excellent communication and relationship building skills are required. As requested, will be expected to research and resolve complex situations and assist with other tasks/projects.


 
DUTIES INCLUDE BUT ARE NOT LIMITED TO:

  • Subject Matter Expert on Credentialing Processing Center policies, procedures and systems.
  • Perform Data Integrity, Specialist Review and/or Compliance Review functions including record preparation, final review and flag assignment based on established CPC requirements.
  • Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare providers per CPC policy and procedures
  • Proactively identify appropriate verification elements in accordance with CPC policy and procedures and as evidenced by QA
  • Assure correct verifications are obtained based on specific provider’s data and CPC policy and procedures, including but not limited to: state license(s), Federal and State DEA(s), board certification, education, and peer references.
  • Monitor collection of all information received, follow up on missing items and/or incomplete forms per CPC policy and procedures; submit follow- up requests for verifications as needed.
  • Identify and evaluate potential flags and work in collaboration with the provider and MSO to document and resolve any potential issues and/or elevations and document in Cactus.
  • Participate in policy development and deployment and CPC Audits.
  • Advise Manager and/or Director of questionable information received and elevate any issues identified during the processes.
  • Maintain all credentials records ensuring that all correspondence in the credentialing and reappointment process is accurately scanned and saved and are within required timeframes.
  • Maintain compliance with  all policy and procedures, Federal and State regulatory and accrediting agencies as required. 
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Perform other duties and/or special projects as assigned

Job Requirements



KNOWLEDGE, SKILLS & ABILITIES

  • Organization – proactively prioritizes needs and effectively manages resources.  Ability to show attention to detail.
  • Communication – communicates clearly and concisely.  Must have excellent interpersonal and written communication skills.  This includes spelling and grammar skills and basic mathematical calculations.
  • Customer orientation – establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
  • Policies & Procedures – articulates knowledge and understanding of organizational policies, procedures, and systems.
  • PC Skills – demonstrates proficiency in Microsoft Office (Excel, Access, Word), Cactus, HCO applications and other business systems as required.
  • Ability to maintain confidentiality of privileged information.
  • Ability to work independently, in teams, and under pressure.
  • Credentialing & privileging technical skills –credentialing process and primary source verification knowledge.
  • Ability to research and resolve complex situations
  • Ability to promote a positive, supportive, healthy work environment.



EDUCATION

  • Associate degree or an equivalent combination of education and experience required. Bachelor Degree preferred. 



EXPERIENCE

  • Minimum two years experience in healthcare credentialing (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office) with one year as a specialist within the Parallon Credentialing Processing Center required.
  • Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred.
  • Completion of credentialing knowledge assessment and post Cactus training testing of 90% or greater.
  • Successful completion of Credentialing 100, 101 and  201
  • Professional telephone etiquette.
  • Able to work with minimal supervision and works well in both individual and group environment. 

CERTIFICATE/LICENSE - NAMSS certified preferred



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