Employment Opportunities
Credentialing Specialist
This position has been filled.
Public?:
Public
Division:
Health
Reports To:
Medical Director
Type of Position:
Regular Full Time
Location:
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
Responsible for assisting the Provider Relations Manager with all aspects of the credentialing, re-credentialing and privileging processes for all practitioners who provide patient care within the Absentee Shawnee Tribal Health System. Responsible for ensuring practitioners are credentialed, appointed and privileged with health plans. Maintain up-to-date data for each practitioner’s confidential credentialing file and practice management system for billing; ensure timely renewal of licenses and certifications.
Responsibilites & Duties
Assist Sr. Credentialing Specialist processing initial credentialing and re-credentialing applications
Screening practitioners’ applications and supporting documentation to ascertain their eligibility
Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer
Collecting primary source credentialing and privileging verification, via AMA, AOA, ECFMG, OIG Exclusions List, Licensing Board, DEA and OBNDD verification, National Student Clearinghouse, Board Certifications
Identifying discrepancies in information and conducting follow up
Presenting applications to the Credentialing Committee
Distribution, research and working knowledge of Medical Staff Bylaws, Rules and Regulations. Assist with the development of the Medical Staff Bylaws, policies, procedures, rules and regulations to ensure that the medical staff is aware of changes.
Prepare reports, letters and other confidential materials
Maintains copies of current state licenses, DEA and OBNDD certificates, malpractice coverage and any other required credentialing documents for all practitioners
Maintains knowledge of current health plan and agency requirements for credentialing practitioners
Assists Provider Relations Manager in setting up and maintaining practitioners information in online credentialing data base and practice management system for billing
Track, validate monthly expiring licensure and certification for all practitioners to ensure timely renewals
Auditing Medical Staff Credentialing Files
Track and log credentialing status routinely with participating insurance networks
Responding to health plan provider inquiries
Ensures practice addresses are current with health plans, agencies and other entities.
Audits health plan directories for current and accurate provider information
Assist Provider Relations Manager in submitting insurance enrollment and contracts
Assist Provider Relations Manager in identifying and reporting any non-compliance or credentialing issues
Maintains confidentiality of practitioner information
Assist Provider Relations Manager/Medical Director with monthly practitioner meetings; Journal Club meetings
Submit reimbursements for licensure, membership, subscriptions and book orders through Microix
Assist Provider Relations Manager/Coordinator with other duties/projects/committee meetings
Assists Medical Director/Deputy Medical Director as needed
Coordinate student schedules with HR, Medical Director, Deputy Medical Director and all other departments as directed
DIA system access form and Provider digital signature forms collected and completed to assist EHR
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Knowledge and understanding of the credentialing and privileging to maintain AAAHC Accreditation
Ability to organize and prioritize work and manage multiple priorities
Ability to work independently with minimal supervision
Performs other duties as assigned
Education Requirements and Qualifications
Required Qualifications:
Education: High School Diploma / Some College Preferred
1-3 years of previous credentialing experience within a healthcare environment
Knowledge and understanding of the credentialing process
Ability to organize and prioritize work and manage multiple priorities
Excellent verbal and written communication skills including, letters, memos and emails
Excellent attention to detail
Ability to research and analyze data
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources
Preferred Qualifications:
Associate degree / Certified Provider Credentialing Specialist (CPCS).
Previous experience working with a Native American entity
Physical Requirements and Working Conditions
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.
Frequent lifting (up to 15 lbs)
Occasional lifting (up to 30 lbs)
Native American Preference/EOE/Drug Free Workplace/Smoke Free Workplace
Posted Date:
1 year 5 months ago