Credentialing Specialist I

Credentialing Specialist I

Job Summary: The Credentialing Specialist I with Choptank Community Health (CCHS) is responsible for the daily operations that support credentialing, re-credentialing, provider set-up, and contract execution/maintenance processes. Ensures compliance with the National Committee for Quality Assurance, URAC, HRSA, and Joint Commission standards regarding credentialing. Serves as clinical administrator for the CQCO, CDO, and CMO. Assists with updating CCHS policies and procedures related to credentialing, privileging, and developing privilege forms for each discipline in coordination with the CDO, CCO, and CMO. This is a nonexempt, full-time position in pay grade 5 with the pay range of $23.73 - $33.23 per hour. The Credentialing Specialist I reports directly to the Chief Quality and Compliance Officer (CQCO).

Required Skills/Abilities:

• Proficient in computer skills, including spreadsheets and credentialing software.
• Detail oriented, self-motivated, reliable, and dependable
• Ability to work with others in a professional manner.
• Ability to effectively communicate orally and in writing.
• Working knowledge of the credentialing process
• Understanding of insurance billing
• Must have a valid driver's license and reliable transportation.

Education and Experience:

• High School diploma or equivalent.
• Associate degree required or equivalent experience.
• Bachelor’s Degree with course work in Business Administration or Health care field preferred
• 3-5 years clinical experience in an ambulatory care setting or health insurance/managed care industry

Working Conditions and Physical Requirements:

• General office environment
• Occasional travel
• Potential for remote work based on performance

Standards of Behavior:

• Commitment To Service
• Respect
• Quality
• Teamwork
• Patient Focus
• Integrity
• Accountability
• Caring & Compassion
• Professionalism
• Listening & Responding
• Safety
• AIDET

Job Related Competencies:

• Attention to Detail- The ability to process detailed information effectively and consistently.
• Problem Solving- Identifies and analyzes problems weighing the relevance and accuracy of available information. Generates and evaluates alternative solutions and makes effective and timely decisions.
• Communicates Effectively- Developing and delivering multi-mode communication that conveys a clear understanding of the unique needs of different audiences.
• Values And Ethics- Serving with integrity and respect in personal and organizational practices. Ensuring decisions and transactions are transparent and fair.
• Time Management- The ability to effectively manage one’s time and resources to ensure that work is completed efficiently.

Commitment to Community:

Choptank Community Health System (CCHS) is committed to creating a safe and open healthcare environment that improves health outcomes and values and respects the unique experiences and perspectives of both patients and staff by:

• Prioritizing access for all individuals;
• Offering ongoing training for staff to promote health awareness, preventive measures
• and early detection for the varied patient population on the Eastern Shore;
• Actively engaging with patients, families and staff;
• Fostering a workplace culture in which everyone is treated with dignity.

Duties/Responsibilities:

• Responsible for Initial Credentialing of all providers and licensed clinical support staff, and re-appointment credentialing every two (2) years.
• Establishes and maintains the CCHS provider credentialing files for initial credentialing, granting clinical privileges (including hospital), and re-credentialing of clinical privileges for all licensed clinical personnel.
• Coordinates the process for obtaining written collaboration or mentor agreements as required for advanced practice clinicians.
• Coordinates renewals of all providers clinical licensure, DEA and CDS certifications, and Board certification
• Assures process for CEO review/approval of initial provider credentialing and re-credentialing.
• Participates in the review and revision of policies pertaining to credentialing.
• Responsible for credentialing providers with insurance carriers that CCHS participates with.
• Establishes and maintains credentials for all providers with appropriate third-party insurance companies, assists with credentialing process at nursing homes and hospitals as indicated.
• Ensures re-validation with insurance companies is done in a timely manner to avoid lapses in credentialing.
• Collaborates with Billing Manager and CFO regarding the credentialing process with insurance companies and providers.
• Provides updated rosters to insurance companies as required.
• Updates EHR with insurance company enrollment status.
• Assists with the placement of student rotations and ensuring all requirements are met for students to be placed at CCHS. Ensures school affiliation agreements are in place prior to student placements. Coordinates with leadership when necessary to obtain affiliation agreements.
• Works closely with HR on orientation schedules for all clinical staff; ensuring credentialing and privileging are completed prior to start dates. Communicates regularly with hiring manager or Chief regarding credentialing and privileging process for newly hired clinical staff.
• Assists CQCO, CDO, CCO, and CMO on assigned tasks.
• Assists in preparing and sending electronic correspondence related to credentialing and privileging as needed.
• Provides administrative and clerical support to CQCO, CDO, CCO, and CMO as needed.
• Assists with ensuring all Administrative Office faxes are routed appropriately.
• HealthStream Administration maintenance; adding or removing employees, changing job titles as appropriate
• Regular, reliable attendance is a requirement of this job.

Benefits:

• Tuition and education assistance
• Certification scholarships available
• Paid holidays (9)
• Flexible paid time off and vacation scheduling
• 403(b)
• 403(b) matching
• Employee assistance program
• Flexible spending account
• Health insurance
• Dental insurance
• Vision coverage
• Life insurance
• Referral program
• Employee wellness program
• Discretionary Bonuses

Choptank Community Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital or family status, veteran status, sexual orientation, gender identity or expression, genetic information, political affiliation, arrest record, or any other characteristic protected by applicable federal, state, or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.