Provider Credentialing Specialist - Windham, United States - DMC Primary Care

DMC Primary Care Windham, United States

2 weeks ago

Description

Job Description

Job DescriptionDMC Primary Care, a physician-owned, independent practice, with offices throughout southern New Hampshire, has been providing comprehensive care for entire families since 1964. We help each patient achieve the best possible health through every stage of life. We do this by providing an accessible, innovative healthcare experience that is built around our patient's needs.

We are hiring a Provider Credentialing Specialist. This is a full-time position in Windham, NH.

The Provider Credentialing Specialist is responsible for overseeing and coordinating DMC's onboarding and credentialing process for new providers and ongoing revalidation. The credentialing specialist will acquire primary source information necessary for DMC employment, as well as both initial and reappointment application or verification with all contracted health plans to ensure that all physician and non-physician provider requirements are met.

DUTIES INCLUDE:

Maintaining a thorough understanding of federal and state regulations, payer policies, and requirements in order to ensure a compliant provider employment and credentialing process for Derry Medical Center
Performing the credentialing and privileging process in accordance with all governmental and commercial payer credentialing applications
Collaborating closely with the Director of Human Resources and Medical Staff Coordinator to assist with DMC's provider onboarding process
Tracking and following up on physicians' initial application/onboarding process and reappointment applications by performing primary source verification, preparing agency correspondence, and tracking responses within the organization's provider database
Maintaining individual provider files with up to date information and completes the revalidation requests issued by all governmental and commercial payers, as well any other DMC employment requirements
Working with necessary individuals—including physicians, Human Resources, other professional staff, and their office or clerical staff—to acquire necessary materials and information for provider certification and licensure
Assisting in filling out and reviewing credentialing applications and other employment requirements with practitioners and other applicable staff
Notifying applicants when further information is requested regarding their background, training, demonstrated ability, previous performance, current competence, physical and mental health status, continuing education, etc.
Maintaining accurate provider profiles on CAQH, PECOS, CMS, and other necessary databases
Safeguarding the integrity of privileged information, credentialing and employment files in a professional and sensitive manner
Identifying sanctioned providers on state and federal disciplinary action reports and initiates the requisite corrective processes to address cited violations
Querying the National Practitioner Data Bank as needed, and does so in compliance with the Healthcare Quality Improvement Act (HCQIA)
Remaining compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid Services, as well as state regulations— and relays this information to the necessary parties to ensure ongoing compliance organization-wide
Providing all office visitors, credentialing contacts, payer representatives, and agency intermediaries with excellent customer service
Collaborating with the billing department to help resolve and denials or authorizations issues related to provider credentialing
Assisting the department manager and related staff with additional administrative tasks as needed
Continuously seeking out further information and education through appropriate resources and references approved by management to research accurate answers and guidance for role and responsibilities. This includes maintaining any necessary reference guides, policies, procedures, FAQs, etc as a resource and reaching out to management and or other appropriate individuals for guidance when research performed does not provide an appropriate resolution
Possessing high-level organizational skills and the ability to multi-task and work under pressure, while presenting a calm, professional manner and positive attitude

EDUCATION & TRAINING:

High school diploma or equivalent required

EXPERIENCE:

At least two years of experience in healthcare provider credentialing required
Proven experience working directly with healthcare personnel, such as physicians, in an office setting required
Experience with Microsoft Office Suite (Word, Excel, Outlook, etc)

LICENSE & CERTIFICATION:

Training, education, or certification in practitioner credentialing preferred

Full time positions offer:

Competitive hourly salary
Comprehensive medical/dental benefits at 32 hours
Paid time off
401K

For more information, please visit

We are an equal opportunity employer embracing the strength that diversity brings to the workplace. We provide a welcoming and supportive environment for employees of all ethnic backgrounds, cultures, ages, lifestyles and physical abilities.

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