Licensing & Credentialing Specialist

Description:

AdaptHealth Opportunity – Apply Today!

At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives, please click to apply, we would love to hear from you.

Position Summary:

The Licensing and Credentialing Specialist assists the Licensing and Credentialing Manager with credentialing and

licensing duties. Responsible for ensuring licensing submissions are executed accurately in accordance with local, state,

and Federal regulations, under the guidance of the Licensing and Credentialing Manager and the Director of Licensing

& Governmental Credentialing. Also responsible for ensuring records are maintained in compliance with company requirements. Submissions must occur within specified deadlines.

Job Duties:

• Maintains working knowledge of licensing and credentialing requirements at the local, state, and Federal level.
• Applies for new business licenses, certifications, and registrations as required to support business operations.
• May process Medicare 855s enrollment applications, updates, revalidations, and voluntary deactivations.
• Processes state Medicaid enrollment and re-enrollment applications.
• Maintains regulatory business information such as: Ownership, officers, Employer Identification Numbers,
• Medicare and NPI Information.
• Processes surety bond applications, renewals, and bond claims.
• Processes Insurance certificate holder requests and insurance claims.
• Maintains incident logs, follow up for completed incident reports and submits claims to insurance carrier as needed.
• May process commercial health plan new contract credentialing and re-credentialing.
• Participates in Medicare Competitive Bidding related activities and contract compliance.
• Responsible for creating and tracking regulatory binders across lines of business.
• Tracks licensure expiration dates and regularly checks to ensure that professionally licensed individuals remain in “good standing” with their respective licensing entities.
• Interfaces with and influences local management to ensure Hazardous Materials laws are followed. Completes
• Hazardous Materials Business Plan (HMBP) program for the company.
• Performs monthly “exclusion list” checks on prescribing practitioners, vendors, and employees (including OIG,
• Sam.gov and 34 exclusion databases). Performs independent research and data analysis to resolve potential matches.
• Alerts chief executives, (Leadership Team) of any established exclusion matches, so that revenue may be reconciled, and steps taken to ensure that matched individuals/entities are excluded from working with thecompany, in accordance with Federal directives.
• Creates and utilizes SharePoint and Excel databases and other reports to track compliance.
• Assists with Patient Privacy (HIPAA)-related matters, as needed.
• Supports the Corporate Compliance Department with a variety of projects as needed.
• Maintain compliance with Federal healthcare regulations.
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program.
• Perform other related duties as assigned.

Competency, Skills and Abilities:

• Knowledge of CMS Quality Standards, DMEPOS Supplier Standards and Accreditation Standards
• Knowledge of PECOS Enrollment System
• Strong ability to establish effective working relationships and builds credibility within the company to support a culture of compliance.
• Demonstrates a high level of confident and clear communication, communicates regularly with regulatory agencies and accrediting bodies with credibility and confidence.
• Excellent verbal and written communication skills.
• Well-organized, detail oriented and possess strong problem-solving and critical thinking skills.
• Ability to prioritize tasks, manage multiple projects and work independently.
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
• Ability to prepare routine reports and correspondence.
• Ability to speak effectively before groups of employees of the organization.
• Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Ability to apply concepts of basic statistics.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Computer Skills: Strong proficiency in Microsoft Office: Excel, Word, Outlook.

Requirements:

Education and Experience Requirements:

• High school diploma or equivalent
• Associate degree in business or health care preferred.
• Four (4) years of accreditation or healthcare compliance experience and/or equivalent

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.