This FT position is responsible for verification and evaluation of provider credentials, physician and NP credentialing and compliance policies, operating procedures and delegated health plans. Maintains accurate records associated with medical staff credentialing and compliance requirements, utilizes the automated systems to support the functions and maintains strict confidence of medical staff information. Able to work under pressure and in situations that demand patience and confidentiality. Enters accurate and updated information in the credentialing system and provider files, this individual will credential and recredential providers; retrieve/review background results; create provider records in the credentialing system.
- A high school diploma or GED.
- One year or more of full-time experience working with HIPAA and compliance credentialing experience.
- Two years of full-time experience working in a professional office environment
- Excellent written and verbal command of English.
- Demonstrated computer data entry skills, including Micro-Soft Office.
- Excellent customer service skills.
- The ability to handle high volumes of files under tight deadlines.
- Familiarity of Provider contracts.
- Clearance screen through the Office of Inspector General (OIG) for federal health programs.
Demonstrated Knowledge, Skills, and Abilities. Candidates must demonstrate the KSAs below:
Position responsibilities include but are not limited to:
- Maintaining organizational compliance with regulatory and accreditation standards.
- Insuring legal compliance under HIPAA regulation standards.
- Communicating with Health Insurance Plans
- Providing HIPAA Orientation, breach investigation and education for entire organization.
- Completes credentialing of physicians, allied health and other practitioners.
- Collaborates in the development, implementation of credentialing processes and adherence procedures
- Completes auditing and validating provider data integrity to ensure accuracy
- Ongoing review and utilization of pertinent data and facts to prove compliance.
- Investigate non-standard requests and problems for both credentialing and compliance issues.
- Responsible for the accuracy and integrity of the credentialing database system and related applications.
- Undergraduate Degree in business or health related field, from accredited university.
- Two or more years of experience working with a managed care plan, HIPAA compliance, credentialing experience/working knowledge