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Altamonte Springs

    credentialing specialist- managed care - Altamonte Springs, FL , USA, United States - Adventist Health System

    Adventist Health System
    Adventist Health System Altamonte Springs, FL , USA, United States

    2 weeks ago

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    Description
    AdventHealth Corporate

    All the benefits and perks you need for you and your family:


    • Benefits from Day One
    • Career Development
    • Whole Person Wellbeing Resources
    • Mental Health Resources and Support

    Our promise to you:
    Joining AdventHealth is about being part of something bigger.

    It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit.

    AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.


    Shift :
    Monday-Friday


    Job Location :
    Remote


    The role you'll contribute:
    Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

    Facilitates all aspects of Adventist Health Systems (AHS) credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts.

    Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

    Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Centralized Verification Office (CVO) Manager.

    The value you'll bring to the team:

    • Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
    • Conducts thorough background investigation, research, and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.
    • Achieves productivity standards as determined by management.
    • Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up.
    • Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.
    • Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
    • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
    • Assists with managed care delegated credentialing audits; conducts internal file audits.
    • Utilizes the MSOW/Apogee credentialing database, optimizing efficiency, and performs query, report, and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
    • Monitors the initial, reappointment and expirable process for all AHS employed physicians, allied health professional staff, other health professional staff, delegated and community CIN providers affiliated with AHS. Responsible for ensuring compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.
    • Performs miscellaneous job-related duties as assigned.
    Qualifications

    The expertise and experiences you'll need to succeed:

    KNOWLEDGE AND SKILLS REQUIRED:

    • Attentive to detail and accuracy; strong organization skills required.
    • Ability to communicate effectively, both orally and in writing.
    • Program planning and implementation skills.
    • Knowledge of related accreditation and certification requirements.
    • Knowledge of medical credentialing and privileging procedures and standards.
    • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
    • Working knowledge of clinical and/or hospital operations and procedures.
    • Informational research skills.
    • Ability to use independent judgment to manage and impart confidential information.
    • Database management skills including querying, reporting, and document generation.
    • Ability to make administrative/procedural decisions and judgments.

    KNOWLEDGE AND SKILLS PREFERRED:

    • MSOW/Apogee
    • Typing 35 wpm
    • MS Office (Excel, Word, Outlook)

    EDUCATION AND EXPERIENCE REQUIRED:

    • High school diploma or GED
    • Minimum 5 years of healthcare experience with 1 year directly related to hospital medical staff or managed care credentialing and/or provider enrollment.
    • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis

    EDUCATION AND EXPERIENCE PREFERRED:

    • AS Degree in healthcare
    • 4 years directly related to hospital medical staff or managed care credentialing and/or provider enrollment.

    LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:


    NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification and secure within 1 year in the role.

    This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.


    Category:
    Managed Care


    Organization:
    AdventHealth Corporate


    Schedule:
    Full-time

    Shift: - Day


    Req ID:


    We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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