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SalaryIt’s inspiring to work with a company where people truly BELIEVE in what they’re doing!
When you become part of the CareNu Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!
Role:The Credentialing Specialist is responsible for coordination and oversight of the Medical Services Department’s Provider credentialing and re-credentialing. Works closely with Medical Staff leaders, Administration, and Legal Counsel with regard to medical staff contracts and bylaws issues. Ensures HIPAA, NCQA, and Joint Commission compliance with regard to credentialing standards.
Qualifications:
- High School Diploma or GED required; College degree in business or health-related field preferred
- Minimum of one (1) year experience in Medical Staff credentialing within Hospital or Physician Practice setting, or applicable Medical Office experience
- CPMSM and/or CPCS Certification by the National Association Medical Staff Services strongly encouraged
- Medical Terminology expertise preferred
- Excellent typing, organizational, and time management skills
- Expert working knowledge of a variety of software including word processing and spreadsheet development
- Well-developed communication (verbal and written including editing documents) and personal relations skills
- Ability to effectively communicate with staff, external agencies, and physicians
- Ability to lead by example, adhering to the highest standards of professional work ethics and confidentiality
Competencies:
- Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment Performance Improvement activities as appropriate for the position.
Job Responsibilities:
- Coordinates with Human Resources, Medical Directors, and Chief Medical Officer for the hiring of prospective new Medical Staff and new contracted providers. Facilitates orientation of new medical staff with AVP of Medical Services.
- Develops, implements and maintains procedure to credential prospective new medical staff and re-credential existing medical staff for all entities within the Organization. Process two-year reappointment updates for all existing medical staff and ensures credentialing processes implemented are compliant with Joint Commission standards.
- Coordinates with Medical Liability Insurance Agent to secure medical liability insurance coverage for prospective medical staff.
- Maintains credentialing database by creating and implementing procedures for medical staff licenses/certifications tracking and updating including, but not limited to, medical license, DEA, UPIN, board certifications, malpractice insurance, CMEs, CEUs, contracts, and privileges. Maintains current medical staff files on each individual member to include all current necessary medical staff documentation and provide credentialing information in a timely manner.
- Secures necessary documentation and assists with completion of applications to obtain privileges in designated hospitals for medical staff.
- Processes applications for community hospital privileges and reappointments including all appropriate documentation and payment.
- Creates, coordinates, and maintains Nurse Practitioner (APRN) protocols Organization-wide with each additional new medical staff member and on an annual basis.
- Processes enrollments for Medicare, Medicaid and other insurance plans.
- Maintains consulting/contracted/Fellow OIG listing and submits monthly to Compliance Department for OIG surveillance.
- Enrolls providers in Dr. First system and processes updates.
- Performs other duties as assigned.
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
