Credentialing Specialist Customer Service

HCA Houston , TX 77020

Posted Today

GENERAL SUMMARY OF DUTIES

This position will be responsible for supporting the development and implementation of the Credentialing Processing Center policies and procedures. This will include, but not be limited to responsibility for credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review. Excellent communication and relationship building skills are required. Will be expected to assist the Manager and Director with other tasks/projects as requested. All activities will be performed for select HCA hospitals within established levels. Compliance with HMA policy and procedure, Federal and State regulatory and accrediting agencies is required.

TRANSITION DUTIES INCLUDE BUT ARE NOT LIMITED TO

  • Assist in planning, developing, implementing process and documentation of processes during migration

  • Assist in establishing, reviewing, and implementing quality controls and reviews during migration

  • Provide input for process design and other implementation activities

  • Manual entry of practitioner data

  • Primary Source Verification of selected items

DUTIES INCLUDE BUT ARE NOT LIMITED TO

  • Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy and procedure

  • Assist in the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes

  • Acts as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to clients in a timely manner

  • Process and maintain credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations.

This will include but not limited to the following verifications:

National Practitioner Data Bank OIG/GSA fro Medicare/Medicaid exemption

DEA Verification Licensure

Board Certification Training verified. Residency/ Fellowship

Peer Recommendation Professional Schooling Verified

  • Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure

  • Monitor collection of all information received; follow up on missing items and/or incomplete forms per CPC policy and procedure, submit follow up requests for verifications as needed

  • Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response

  • Advise Manager and/or Director of questionable information received and any issues identified during the processes

  • Submit closed files for audit/final review and secure missing items as identified by audit/final review

  • Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements

  • Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies as required

  • Perform other duties and works on special projects as requested

  • Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"

  • Perform other duties as assigned

EDUCATION

Associate degree or an equivalent combination of education and experience required. Bachelor Degree preferred.

EXPERIENCE

  • Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office)

  • Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred

  • Demonstrated working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred

  • Completion of post Cactus training testing of 90% or greater

  • Understanding of professional telephone etiquette

  • Able to work with minimal supervision and works well in both individual and group environment

CERTIFICATE/LICENSE

NAMSS certified at CPCS level preferred, or a commitment to pursue certification within one year


Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Credentialing Specialist

Wellcare Health Plans Inc.

Posted 2 days ago

VIEW JOBS 6/16/2018 12:00:00 AM 2018-09-14T00:00 Provider, Facility and Ancillary credentialing, to include all aspects of new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; online verifications; administrative support of credentialing functions. Reports To: Director, Credentialing Department: Operations Position Location: Houston, TX 77081 Essential Functions: * Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing. * Perform all required primary source verifications. * Contact hospitals, licensing agencies, malpractice carriers, and medical schools to obtain credentialing verifications. * Maintain and update credentialing database records. * Review malpractice history, regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures. * Review the CAQH system and download applications or supplemental documents as appropriate. * Maintain electronic provider files. * Perform outreach to providers and facilities via phone calls and fax/email correspondence. * Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.). * Perform other duties as assigned. Additional Responsibilities:Candidate Education: * Required A High School or GED Candidate Experience: * Required 2 years of experience in a customer service or healthcare related position * Preferred 1 year of experience in Credentialing Candidate Skills: * Intermediate Demonstrated written communication skills * Intermediate Demonstrated interpersonal/verbal communication skills * Intermediate Ability to work as part of a team * Intermediate Ability to effectively present information and respond to questions from peers and management * Intermediate Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing Licenses and Certifications: A license in one of the following is required: * Preferred Other Certified provider credentialing specialist or directly related or equivalent work experience Technical Skills: * Required Intermediate Microsoft Word * Required Intermediate Microsoft Excel * Required Intermediate Microsoft Outlook * Required Intermediate Other Ability to learn various software packages as may be necessary to perform job functions Languages: Wellcare Health Plans Inc. Houston TX

Credentialing Specialist Customer Service

HCA