Credentialing Representative

This position is responsible for accurately preparing, submitting and following up on all credentialing for new providers under PBS Billing. Responsible for Medicare and Medicaid revalidation processes. Also provides support to the Assistant Director Revenue Cycle related to activities as directed to ensure efficient, effective operations of the billing department as related to credentialing.

Education

Minimum: High School Diploma or equivalent

Preferred: Graduate of a Medical Secretary or Medical Billing Program

Registration/Certification/Licensure:

N/A

Experience

Minimum: Two years secretarial or data entry experience within a confidential office setting.

Preferred: Previous insurance credentialing experience.

Other Requirements:

Proficient in the use of Microsoft Office software/products.

Status:

Non-Exempt

Physical Requirements:

The following frequency definitions apply to all Physical Requirements unless otherwise noted:

Occasional: (0-1/3 of day , 0 - 2.5 hrs/day, 1 - 4 reps/hr)

Frequent: (1/3 -2/3 of day , 2.5 - 5.5 hrs/day, 5 -24 reps/hr)

Constant: (> 2/3rd of day , > 5.5 hrs/day, > 24 reps/hr)

NOTE: An asterisk (*) indicates that the item is an essential function.

Non-Material Handling

●Standing

• Remaining on one's feet in an upright position remaining stationary

• OCCASIONAL

●Walking

• Remaining upright on one's feet, and moving about

• OCCASIONAL

●Sitting* - Body remains in a seated position

• CONSTANT

●Stooping

• To bend the body downward and forward by bending the spine at the waist

• OCCASIONAL

●Bending

• To flex the upper body forward

• N/A

●Twisting

• To rotate the upper body forward

• N/A

●Climbing

• To move the body in any direction on equipment or structures that do not include stairs or ladders

• N/A

●Ladders

• To ascend and descend ladders

• N/A

●Stairs

• To ascend and descend stairs

• OCCASIONAL

●Kneeling

• To move the body downwards and come to rest on both hands and both knees

• N/A

●Squatting

• To move the body downwards by bending both knees

• N/A

●Crouching

• To bend the body forward and downward by bending the spine and the legs

• N/A

●Crawling

• To move the body forward or backwards on hands and knees

• N/A

●Reaching Horizontal*

• To extend the arms and hands outward, remaining under shoulder height

• FREQUENT

●Reaching Overhead

• To extend the arms and hands up and out over shoulder height

• N/A

●Grasping

• Using functional gripping of the hand to handle an object

• OCCASIONAL

●Finger Manipulation*

• To manipulate objects with the use of fingers

• OCCASIONAL

●Seeing*

• Using visual feedback to accomplish a task or activity

• CONSTANT

●Hearing*

• Using sound feedback to accomplish a task or activity

• FREQUENT

●Repetitive Upper Extremity Use*

• Using the arms and/or hands continuously or more than 2/3 of the total time

• CONSTANT

●Repetitive Lower Extremity Use

• Using the legs and/or feet continuously or more than 2/3 of the total time

• N/A

Material Handling

●Pushing

• To exert a force upon an object in order to move it in a certain direction Pushing refers to moving an object away from the person

• N/A

●Pulling

• To exert a force upon an object in order to move it in a certain direction Pulling refers to moving an object towards the person

• N/A

●Lift

• Floor to Waist

●OCCASIONAL

●Up to 20#

●Lift

• Waist to shoulder

• N/A

●Lift

• Shoulder to overhead

• N/A

●Carrying*

• To transport an object or article using the arms or hands (> 10 feet)

●FREQUENT

●Up to 10#

Environmental Factors

●Working alone

• FREQUENT

●Working in cramped quarters

• N/A

●Constant interruptions

• OCCASIONAL

●Working with hands in water

• N/A

●Use of power tools

• N/A

●Working on ladders/scaffolding

• N/A

●Exposure to vibration

• N/A

●Exposure to dust

• N/A

●Exposure to noise (constant)

• N/A

●Exposure to electrical energy (outlets, etc)

• N/A

●Exposure to temperature changes (heat, cold, humidity), that require special clothing

• N/A

●Exposure to slippery walking surfaces

• N/A

●Exposure to solvents, grease, oils

• N/A

●Exposure to radiant energy, ie computer terminal (more than 4 hours per shift)

• CONSTANT

●Working with bloodborne pathogens

• N/A

Cardiovascular Energy Requirements

• Physical Demand

Physical Demand

Met Level

Examples of similar activity intensity

Sedentary to Light 0 - 3.5 Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work. Medium 3.6 - 6.3 House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk/run-play with children, aerobic class, dancing, carrying bucket/wood, auto body repair, shoveling snow, golf (carrying clubs). Heavy to Very Heavy > 6.4 Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailing hay, fire fighting, sawing by hand, splitting wood.

As relates to this position:

●Sedentary to Light

• CONSTANT

●Medium

• N/A

●Heavy to Very Heavy

• N/A

I. Specific Job Responsibilities (Essential Functions):

1.Obtains and compiles accurate data for new providers requiring credentialing, works all revalidation requests, updates payers with practice location additions and changes including CLIA licensures, as well as, update payers with physician terminations.

Meets Expectations Does Not Meet

2.Maintains and updates CAQH provider file during initial credentialing process and responsible for the follow up of CAQH for specified clients.

Meets Expectations Does Not Meet

3.Maintains knowledge of payer credentialing processes and regulations including locums and hospital based versus office based providers.

Meets Expectations Does Not Meet

4.Follow up on all outstanding applications in a timely manner and ensures practice addresses are current with health plans.

Meets Expectations Does Not Meet

5.Prepares reporting to BMP management and billing staff of credentialing status.

Meets Expectations Does Not Meet

II. Organizational Responsibilities:

1.Completed mandatory education, annual competencies and department specific education within established timeframes.

Meets Expectations Does Not Meet

2.Completed annual employee health requirements within established timeframes.

Meets Expectations Does Not Meet

3.Maintained license/certification, registration in good standing throughout fiscal year.

Meets Expectations Does Not Meet N/A

4.Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self. Identifies and works to reduce potentially unsafe patient care or other safety practices.

Meets Expectations Does Not Meet

5.Adheres to regulatory agency requirements, survey process and compliance.

Meets Expectations Does Not Meet

• Please use the following to determine the rating for Section I and Section II:

●If employee is rated "Meets" at least 7 of 10 in Sections I and II, their rating is "Meets".

●If employee is rated "Does Not Meet" for 4 or more in Sections I and II, their rating is "Does Not Meet".

Based on the above, the rating for Section I and Section II is:

Meets Expectations Does Not Meet

III. Job Behaviors:

1. "Sets the Stage" by using greetings/introductions when interacting with any customer or entering a patient room. Looks and acts like a professional. Uses consistent phone etiquette. Helps people who look lost or confused. Keeps a clean and professional environment and work space. Clarifies expectations and creates positive handoffs and positive lasting impressions.

Exceeds Expectations Meets Expectations Does Not Meet

2.Fosters a teamwork approach by respecting other members of the hospital team. Stays involved and informed of happenings within the organizations. Creates win-win situations by helping others. Works to resolve conflicts and concerns in a constructive way and asks for assistance in helpful ways.

Exceeds Expectations Meets Expectations Does Not Meet

3.Is the Owner: Takes responsibility for problems, issues or opportunities for improvement by initiating constructive review of concern rather than negatively attacking an issue. Understands systems and processes and uses appropriate channels to address concerns when out of own span of control. Demonstrates compassion and works beyond "own assignment" by seeing "big picture".

Exceeds Expectations Meets Expectations Does Not Meet

4.Creates a Caring Environment by communicating in helpful ways. Always protects the confidentiality and dignity of patients and others. Listens with empathy and understanding and provides options and choices.

Exceeds Expectations Meets Expectations Does Not Meet

5.Provides Great Explanations through user-friendly information and explanations (uses language others can understand). Makes sure people know what they can and cannot expect and checks for understanding and agreement.

Exceeds Expectations Meets Expectations Does Not Meet

• Please use the following to determine the rating for Section III:

●If employee is rated "Exceeds" for at least 3 of 5 AND is rated "Meets" for the remaining, their rating is "Exceeds".

●If employee is rated "Exceeds" for less than 3 of 5 and "Meets" for the remaining, their rating is "Meets".

●If employee is rated "Does Not Meet" for 2 or more, their rating is "Does Not Meet".

Based on the above, the rating for Section III is:

Exceeds Expectations Meets Expectations Does Not Meet

IV. Overall Performance Summary:

Based on the rating for combined Section I and II, and rating for Section III, please select the overall rating for this evaluation period using the outline below.

Exceeds Expectations: Demonstrates exceptional behaviors and exceeds position requirements. Willingly accepts additional responsibilities. Demonstrates expertise in relevant skills and utilizes knowledge to support overall department/organizational goals

Defined as:

●Employee rates "Meets Expectations" for 10 out of 10 in Sections I and II

●Employee rates "Exceeds Expectations" in Section III

Meets Expectations: Achieves and may occasionally exceed performance expectations while demonstrating expected behaviors.

Defined as:

●Employee rates "Meets Expectations" in Sections I and II

●Employee rates "Meets Expectations" in Section III

Does Not Meet Expectations: Performance improvement is needed in one or more areas of expected behaviors or job results.

Defined as:

●Employee rates "Does Not Meet" for their overall rating for Section I and Section II OR for Section III

• Please select the appropriate Overall Performance Summary rating for the review:

Exceeds Expectations Meets Expectations Does Not Meet

Value Equation:

As an organization we prioritize the delivery of a valuable offering to those we serve. For Independence Health System, that means delivering the highest quality of service at a reasonable cost all the while exceeding expectations related to the level of service.

●Please describe how you have contributed to and supported the BHS Value Equation:

Click to enter details N/A (Manager only)

Development and Training:

Employee future development goals/objectives:

Click to enter details N/A (Manager only)

Reviewer recommendation for further development and training for purposes of preparing for additional responsibilities or for the improvement of current job performance:

Click to enter details N/A

Ongoing Counseling for Performance Behaviors:

Reviewer: Please indicate whether employee was disciplined during the course of this review period and if so indicate at which level and the reason(s).

Select below:

Not disciplined during this review period Disciplined during this review period at a level of:

Please select level:

Oral Counseling Written Probation Suspension* N/A

If disciplined during this review period, indicate reason: (note: if multiple reasons apply, please select "Other")

Absenteeism Tardiness Policy Violation Dress Code Improper Conduct Unsatisfactory Performance Improper Attitude Other N/A

Note: If suspended for any reason during the fiscal year, employee will not be eligible for any increase.

Education:

Employee to complete the following:

●Highest Level of Education Completed:

HS Associate Bachelor Masters Doctorate N/A

●Course of Study/Major for Highest Level of Education Completed:

Click to enter details N/A (Manager only)

●License(s)/Certification(s)/Registration(s) currently held:

Click to enter details N/A (Manager only)

Acknowledgement:

Review Acknowledgement: My signature indicates that I have had an opportunity to review and discuss my performance review with my reviewer. I further acknowledge that my signature indicates that I have reviewed the content of the performance review, not whether I agree or disagree with it.

Acknowledgement of Code of Conduct : My signature below indicates that I acknowledge that I have received and have read a copy of the Independence Health System Code of Conduct Policy. I know that additional copies are available to me through the company intranet or that I may also receive a copy by requesting one from my manager, the Human Resources Department, or from the Corporate Compliance Officer. I agree to abide by this policy and if there is anything I don't understand I will contact my manager or the Corporate Compliance Officer at Ext. 5924 for clarification. I also verify that I am not aware of any conduct or action on the part of any Independence Health System or Butler Memorial Hospital employee, staff member or supplier of goods or services that I reasonably believe is or could be a violation of the Independence Health System Code of Conduct. If I wish to report any concern or action, I may do so by placing a call to the Compliance Hotline by dialing 1-855-661-0965.