BPN Credentialing Specialist

GENERAL SUMMARY: The BPN Credentialing Specialist is responsible for credentialing the Bryan Physician Network physicians and advanced practice providers, keeping their hospital and clinic privileges current, and maintaining current applications for managed care and commercial insurance contracts.

PRINCIPAL JOB FUNCTIONS: 1. *Commits to the mission, vision and beliefs of Bryan Health and consistently demonstrates our core values. 2. *Keeps the licenses, certificates and Drug Enforcement Agency#s (DEA) compliance documentation current for the Clinic physicians and advanced practice providers. 3. *Completes new and renewal applications for privileges at various hospitals and clinics for the Clinic#s physicians and advanced practice providers. 4. *Completes new and renewal applications for various managed care and commercial healthcare insurance contracts. 5. Assists in the preparation of the applications and renewal of professional liability insurance for the Clinic#s physicians and advanced practice providers. 6. Responsible for loading and updating the referring physicians in the practice#s database. 7. Assists the billing department with interoffice mail duty and telephone backup when needed. 8.

Performs other related projects and duties as assigned. (Essential Job functions are marked with an asterisk ##. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed. REQUIRED KNOWLEDGE, SKILLS AND ABILITIES: 1. Knowledge of Clinic policies and procedures. 2.

Knowledge of managed care and commercial healthcare insurance contract renewal procedures. 3. Knowledge of professional liability insurance renewal procedures. 4. Knowledge of healthcare provider licensing, certification, credentialing and DEA compliance requirements and procedures. 5.

Knowledge of HIPAA compliance procedures. 6. Knowledge of computer word processing and spreadsheet applications. 7. Knowledge of Corporate compliance plan. 8.

Skill in using office equipment and computer applications. 9. Skill in written and verbal communications and customer relations. 10. Ability to gather reporting information regarding licensure, certification, credentialing and compliance. 11.

Ability to communicate clearly in person and on the phone. 12. Ability to establish and maintain cooperative relationships with physicians, other clinic staff and outside professionals and agencies. 13. Ability to organize and prioritize tasks effectively. 14.

Ability to read, understand and follow oral and written instructions. 15. Ability to concentrate and pay close attention to detail. 16. Ability to maintain the strictest confidentiality. 17.

Ability to maintain regular and punctual attendance. EDUCATION AND EXPERIENCE: High school diploma or equivalent.

Some post-high school education is preferred. Minimum of one (1) year secretarial experience in a medical office setting preferred.

GENERAL SUMMARY:

The BPN Credentialing Specialist is responsible for credentialing the Bryan Physician Network physicians and advanced practice providers, keeping their hospital and clinic privileges current, and maintaining current applications for managed care and commercial insurance contracts.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision and beliefs of Bryan Health and consistently demonstrates our core values.

2. *Keeps the licenses, certificates and Drug Enforcement Agency's (DEA) compliance documentation current for the Clinic physicians and advanced practice providers.

3. *Completes new and renewal applications for privileges at various hospitals and clinics for the Clinic's physicians and advanced practice providers.

4. *Completes new and renewal applications for various managed care and commercial healthcare insurance contracts.

5. *Assists in the preparation of the applications and renewal of professional liability insurance for the Clinic's physicians and advanced practice providers.

6.Responsible for loading and updating the referring physicians in the practice's database.

7.Assists the billing department with interoffice mail duty and telephone backup when needed.

8.Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1.Knowledge of Clinic policies and procedures.

2.Knowledge of managed care and commercial healthcare insurance contract renewal procedures.

3.Knowledge of professional liability insurance renewal procedures.

4.Knowledge of healthcare provider licensing, certification, credentialing and DEA compliance requirements and procedures.

5.Knowledge of HIPAA compliance procedures.

6.Knowledge of computer word processing and spreadsheet applications.

7.Knowledge of Corporate compliance plan.

8.Skill in using office equipment and computer applications.

9.Skill in written and verbal communications and customer relations.

10. Ability to gather reporting information regarding licensure, certification, credentialing and compliance.

11. Ability to communicate clearly in person and on the phone.

12. Ability to establish and maintain cooperative relationships with physicians, other clinic staff and outside professionals and agencies.

13. Ability to organize and prioritize tasks effectively.

14. Ability to read, understand and follow oral and written instructions.

15. Ability to concentrate and pay close attention to detail.

16. Ability to maintain the strictest confidentiality.

17. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent.

Some post-high school education is preferred. Minimum of one (1) year secretarial experience in a medical office setting preferred.