Job Description

Credentialing Specialist - Staff Credentialing - Full Time at Christus Health summary:

The Credentialing Specialist processes credentialing and re-credentialing applications for healthcare practitioners, ensuring compliance with NCQA, Joint Commission, and URAC standards. They conduct thorough background checks, maintain credentialing databases, assist with audits, and manage billing functions related to credentialing services. The role requires healthcare knowledge, administrative skills, and experience working in medical credentialing or similar environments.

Summary:

Processes credentialing and re-credentialing applications of practitioners, reviews application, prepares verification letters, track responses, follows-up for needed information. Conduct background investigations on practitioners including licensure, education and post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence, in accordance with NCQA, Joint Commission and URAC credentialing standards and other established principles of legal documentation and confidentiality. Maintains credentialing database by entering accurate and up-to-date data for each applicant into the database. Responsible for the accuracy and integrity of the data entered. Assists credentialing staff with duties such as making copies, preparing mailings, attending staff meetings, preparing minutes, etc. Responsible for FCI Billing functions including distribution of funds on a weekly basis. Primary focus is participating in the completion of the tasks and assisting staff with complex tasks or problem area. Secondary task is to monitor completion of tasks by work group, including input into work assignments.

Responsibilities:

• Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability.
• Assists in the credentialing/recredentialing process ensuring work is performed in accordance with ALT Policies and Procedures, as well as NCQA, Joint Commission and URAC credentialing standards, and other applicable state and federal regulations.
• Maintains a working knowledge of NCQA, Joint Commission and URAC credentialing standards. Working to attain certification upon meeting NAMSS qualifications to sit for the exam
• Audits credentials files in accordance with ALT Policies and Procedures and in accordance with NCQA, Joint Commission and URAC credentialing standards.
• Diplomatically employ public relations skills in a wide variety of personal/phone contacts with external sources for purposes of soliciting information essential to credentials investigations, including state licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials and credential staff, practitioners and their office staffs.
• Assist in monitoring of expirations of various state licenses, certificates, malpractice insurance and board certifications; initiates proper correspondence and follow-up.
• Assist in daily processing of Non-Staff Care Giver applications as needed.
• Enters a variety of data into ECHO database. Responsible for the integrity and accuracy of the data entered.
• Assist in maintenance of credentials files.
• Seeks direction from Credentials Coordinator or Director when problems are outside standard processes.
• Extensively review and analyze practitioner's credentials documents including certificates of education, residency and fellowship training, and board certification and eligibility; licensure, professional work history, liability insurance and malpractice records. Assess completeness of information and applicants’ qualifications relative to established policies and procedures, NCQA, Joint Commission and URAC credentialing standards as required.
• Assist with preparation for delegated credentialing audits of credentials files.
• Coordinate with appropriate personnel to schedule office site visits, as needed, for appointment and reappointment of ALT practitioners.
• Serves as office liaison for FCI Process including but not limited to contract maintenance, operational issues, and database maintenance.
• Responsible for all aspects of the FCI operational billing process to include re-pricing, billing, collections and distribution of funds. Retains accurate records and researches any issues.
• Assists Executive Director as necessary to pull reports and information relative to the FCI contract.
• Oversees the credentialing process, identifying areas of opportunity to modify established department procedures, processes and policies.
• Performs audits of Credentialing Assistants work to ensure accuracy with internal policies, NCQA and TJC guidelines
• Performs audits of Credentialing Assistants log information into Activity Logs, Credit Card Logs, etc for accuracy.
• Provides insight to Credentialing Assistants regarding the credentialing process and related questions
• Performs any other duties as may be required.

Requirements:

Education/Skills

• College degree preferred.
• Basic computer knowledge.
• Ability to communicate effectively, both verbally and in writing.
• Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of the academic requirements.
• Medical terminology recommended.
• Knowledge of ECHO, Word, Excel, and Access preferred. Must be organized and be able to work quickly, independently, and with little supervision.

Experience

• Two years experience in healthcare setting.
• Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of the academic requirements.

Licenses, Registrations, or Certifications

• High school diploma or equivalent.
• Coding certification within one year of employment.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Keywords:

credentialing specialist, healthcare credentialing, practitioner verification, NCQA standards, Joint Commission, URAC credentialing, medical credentialing, credentialing audits, healthcare administration, credentialing database management

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