Credentialing Specialist - Fresno, United States - Valley Health Team Inc

Description

Job Description

The Credentialing Specialist is responsible for the initial and ongoing credentialing and privileging process of all new and established providers and clinical staff. Tracks all re-credentialing, prepares and submits required forms, gathers needed documentation and information for review and final approval by the Board. Maintains current knowledge of eligibility and enrollment requirements and communicates changes to Director of Human Resources and Chief of Quality Improvement. In addition, this position will support the HR department in general human resources activities as needed.

• Review credentialing of medical providers (LIP) and clinical staff (OLCP and OCS) assure that all documentation has been obtained, reviewed, and verified.
• Responsible for submitting and updating credentialing documents to all necessary agencies for providers and clinical staff prior to their start date; submit credentialing and privilege documentation to necessary departments for health plan credentialing and for grant purposes.
• Maintain current credentialing files for all providers and clinical staff: medical, dental, optometry, behavioral health, etc.; updating as necessary or required.
• Handle requests for copies of records or other data; support patients and staff needs by researching questions, calls, and requests for information; responds to correspondence within sphere of knowledge and distribute to appropriate individuals.
• Maintain malpractice insurance policies, complete reports, and renewal applications.
• Shall implement a credentialing tracking system for license, DEA and professional liability expirations and will maintain a database on all; provider, licensed/certificated staff.
• Track all CME requirements for each professional employee in accordance with current policy and as required by funding, licensing, and credentialing requirements; sends out notifications prior to deadlines.
• Remain current on all aspects of managed care and regulations and health plan requirements; communicate changes to appropriate management and affected staff.
• Ensure that clinician staff is eligible to work through annually queries of National Practitioners Data Bank in accordance with VHT credentialing protocol.
• Get new providers' National Provider Identifier (NPI) numbers in accordance with HIPAA regulations.
• Support the continual credentialing functions by facilitating clinician requests for re-certifications (e.g. DEA, State Practice License, BLS card, etc.)
• Assist providers with initial process of CAQH and PECOS and re-attestation of CAQH.
• On a temporary basis, may be required to work at any satellite facility.
• Contribute to team effort by assisting the HR department as needed and while maintaining confidentiality of VHT's business.
• Work cooperatively with all staff members and outside sources in a professional manner to deliver a high level of service.
• Observe and practice all VHT Patient Experience Service Standards as outlined in "World Class Practices: My Commitment to Care (which I have read and signed). Practice CICARE when interacting with patients, their families, visitors, or internal customers.
• Practice CICARE phone etiquette during all phone interactions.
• Always exercise courtesy whenever patients, family members, visitors and co-workers are present.
• Respect privacy and dignity of our patients, family members, visitors and co-workers.
• Maintain professionalism in the presence of patients, their families, visitors and co-workers.
• Act as a role model, verbally and behaviorally demonstrating skill, enthusiasm, positive problem solving, commitment and loyalty to the profession and the organization.
• Follow applicable regulations: Joint Commission, OSHA, HIPAA, and CLIA.
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements, and The Joint Commission Accreditation of Healthcare Organization standards.
• Perform other related duties, which may be inclusive, but not listed in the job description.

• Review credentialing of medical providers (LIP) and clinical staff (OLCP and OCS) assure that all documentation has been obtained, reviewed, and verified.
• Responsible for submitting and updating credentialing documents to all necessary agencies for providers and clinical staff prior to their start date; submit credentialing and privilege documentation to necessary departments for health plan credentialing and for grant purposes.
• Maintain current credentialing files for all providers and clinical staff: medical, dental, optometry, behavioral health, etc.; updating as necessary or required.
• Handle requests for copies of records or other data; support patients and staff needs by researching questions, calls, and requests for information; responds to correspondence within sphere of knowledge and distribute to appropriate individuals.
• Maintain malpractice insurance policies, complete reports, and renewal applications.
• Shall implement a credentialing tracking system for license, DEA and professional liability expirations and will maintain a database on all; provider, licensed/certificated staff.
• Track all CME requirements for each professional employee in accordance with current policy and as required by funding, licensing, and credentialing requirements; sends out notifications prior to deadlines.
• Remain current on all aspects of managed care and regulations and health plan requirements; communicate changes to appropriate management and affected staff.
• Ensure that clinician staff is eligible to work through annually queries of National Practitioners Data Bank in accordance with VHT credentialing protocol.
• Get new providers' National Provider Identifier (NPI) numbers in accordance with HIPAA regulations.
• Support the continual credentialing functions by facilitating clinician requests for re-certifications (e.g. DEA, State Practice License, BLS card, etc.)
• Assist providers with initial process of CAQH and PECOS and re-attestation of CAQH.
• On a temporary basis, may be required to work at any satellite facility.
• Contribute to team effort by assisting the HR department as needed and while maintaining confidentiality of VHT's business.
• Work cooperatively with all staff members and outside sources in a professional manner to deliver a high level of service.
• Observe and practice all VHT Patient Experience Service Standards as outlined in "World Class Practices: My Commitment to Care (which I have read and signed). Practice CICARE when interacting with patients, their families, visitors, or internal customers.
• Practice CICARE phone etiquette during all phone interactions.
• Always exercise courtesy whenever patients, family members, visitors and co-workers are present.
• Respect privacy and dignity of our patients, family members, visitors and co-workers.
• Maintain professionalism in the presence of patients, their families, visitors and co-workers.
• Act as a role model, verbally and behaviorally demonstrating skill, enthusiasm, positive problem solving, commitment and loyalty to the profession and the organization.
• Follow applicable regulations: Joint Commission, OSHA, HIPAA, and CLIA.
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements, and The Joint Commission Accreditation of Healthcare Organization standards.
• Perform other related duties, which may be inclusive, but not listed in the job description.