Credentialing Specialist in Nashville at Parallon

Date Posted: 7/26/2019

Job Snapshot

Job Description

This is a 32 hour a week position.  
GENERAL SUMMARY OF DUTIES – 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, and 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 assist the Manager(s) and Director(s) with other tasks/projects. All activities will be performed for select HCA entities within established levels. Compliance with HCA policy and procedure, Federal and State regulatory, and accrediting agencies is required.
• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare providers per CPC policy and procedures
• Assist in the credentialing process by entering / logging/ scanning information into credentialing system for initial, updated, add on applications and maintenance processes
• Proactively identify appropriate verification elements in accordance with CPC policy and procedures and as evidenced by QIS QA
• Assure correct verifications 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 provider to document, resolve, and document in Cactus to communicate thoroughly with MSO
• 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.
• Compliance with HCA policy and procedures, Federal and State regulatory and accrediting agencies as required.
• Perform other duties and works on special projects as requested.
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• 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, and HCO applications and other as required.
• Ability to maintain confidentiality of privileged information gained.
• Ability to work independently, in teams, and under pressure.
• Credentialing & Privileging technical skills –credentialing process and primary source verification knowledge.
• Associate degree or an equivalent combination of education and experience required. Bachelor Degree preferred.
• Minimum one-year experience in healthcare credentialing (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office) preferred
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
• Completion post Cactus training testing of 80% or greater.
• Understanding of professional telephone etiquette
• Able to work with minimal supervision and works well in both individual and group environment
CERTIFICATE/LICENSE - NAMSS certified preferred
PHYSICAL DEMANDS/WORKING CONDITIONS - Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people.