Credentialing Specialist

Job Type
Full-time
Description
Position Summary
The Credentialing Specialist provides administrative support to the Compliance Department and completes all credentialing activities in accordance with Heartland Health Services' (HHS) mission and strategic goals, federal and state laws and regulations, performance and outcome objectives, and accreditation standards.
Essential Functions

• Compiles and maintains current and accurate data for all clinicians.
• Completes clinician credentialing packet(s) and prepares them for submission to the QAUR (Quality Assurance Utilization Review) Committee and Board of Directors. Acquires updated credentialing documentation for re-credentialing of clinicians.
• Completes initial site credentialing and re-credentialing processes.
• Works in consultation with Human Resources to ensure complete and accurate employee documentation.
• Works with the Finance department to complete clinician insurance credentialing while also maintaining accurate practice locations and areas of expertise.
• Maintains the files and documentation and knowledge of all guidelines associated with credentialing, re-credentialing, and license renewals.
• Responsible for the verification and legitimacy of all practicing and initial credentialing including education, licensing, experience, and all information required by regulatory agencies.
• Works with clinicians and staff members in a positive manner.
• Supports clinic compliance with all applicable federal, state, local, and HHS rules, regulations, protocols, and procedures governing the clinical provision of medical services as well as those relating to, but not limited to, workplace safety, public health, and confidentiality.
• Supports and is involved in HHS's continuous quality improvement efforts designed to improve patient outcomes.
• Works in consultation with clinical teams, direct clinical support staff, and indirect clinical support staff to develop and implement policies and procedures that maximize patient-centered communication and services.
• Maintains and assures confidentiality of patient information in accordance with HHS's policies.
• Reports building/equipment problems through the appropriate channels.
• Performs any clerical duty or department related task as assigned by supervisor in a continuously changing medical practice.
• Attends all staff meetings, department meetings, and any other meetings as required.

• One plus years college preferred or three-five years progressively responsible administrative assistant experience (or equivalent), preferably in a clinical area with clinician credentialing experience
• Strong computer skills including Word, Excel, Outlook, PowerPoint, database management, and internet/intranet
• Possesses a high degree of integrity and strong work ethic
• High level of initiative, tact, judgment, and organizational skills
• Excellent interpersonal assessment, communications, and teamwork skills
• The ability to work in a fast-paced environment
• Ability to travel to all locations and meetings outside of service area; flexible hours required