Job Summary
Responsible for supporting the initial credentialing responsibilities of assigned established and new accounts to include submitting a complete application timely to our hospital partners, preparing state collaborative documentation for advanced practitioners and monitoring licensing application process. Ensures providers are privileged in a timely and in an efficient manner. Follows established Standard Operating Procedures (SOP’s); notifications; reference guides; policies and procedures, etc.
Essential Functions
Facilitates the pre-filling; sending and receiving of accurate and complete credentialing information; tracks and reports progress and performs follow-up activities as needed until provider file is complete and provider is awarded privileges. Reviews the documents collected during onboarding to confirm they meet state, federal, and hospital partner requirements to include a current state license, CSR (if required), and DEA certificates to practice in contracted states. Validates and verifies data entered in the credentialing database to ensure accurate and comprehensive. Partners with credentialing leadership to ensure successful launches of new accounts in assigned territory. Ensures timely issue of COI and enrollment in any state patient compensation funds through completion of the insurance application for all assigned providers. Prepares and submits state collaborative documentation for advanced practitioners and ensures continuous compliance with the state. Coordinates the license, CSR, and DEA requests with the third-party service and monitors from initiating the request to issuance of the credentials. Escalate concerns regarding the licensing, state collaborative, and privileging of providers and non-response to management. All other duties as assigned.Qualifications
High school diploma or equivalent required (Bachelor’s degree preferred) 3-5 years of relevant credentialing experience required. Certified Provider Credentialing Specialist (CPCS) preferred. Basic computer and keyboarding skills required.Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:
The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions. Continuous sitting, repetitive use of arms, hands, and fingers may also be required.
The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.