Credentialing Specialist
Company Name:
Peace River Center
JOB DESCRIPTION
CREDENTIALING SPECIALIST
JOB TITLE: Credentialing Specialist
EFFECTIVE DATE: 2014
PROGRAM: Human Resources
REPORTS TO: Chief HR Officer
FACILITY: Main Street
CITY: Bartow, Florida
JOB STATUS: Permanent - Full time/hourly
FLSA: Non Exempt
Job
Summary:
This position is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all staff and consultants who provide patient care services at Peace River Center. The position is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities; maintaining up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
1. Responsible for maintaining and implementing the credentialing and re-credentialing process for PRC in accordance with The Joint Commission standards and other State and Federal Regulatory agencies.
2. Responsible for maintaining all credentialing functions in collaboration with other department employees to include intake, primary source verification, documentation and tracking of applications and re-applications for Medical Staff membership and clinical privileges and applications and re-applications for allied health professionals according to national quality standards
3. Participates in development and implementation of credentialing processes and procedures.
4. Compiles and maintains current and accurate data for all providers.
5. Utilizes independent judgment in determining the completeness of information prior to processing applications/reapplications. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
6. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
7. Maintains provider contract files.
8. Maintains knowledge of current health plan and agency requirements for credentialing providers.
9. Ability to reference Accreditation Manual for Hospitals of The Joint Commission on Accreditation of Healthcare Organizations and other regulatory agencies.
10. Maintains written and verbal correspondence with applicants and references regarding status of the applications/reapplications and provides appropriate follow up in deficient areas in the application.
11. Sets up and maintains provider information in online credentialing databases and systems.
12. Tracks license and certification expirations for all providers to ensure timely renewals.
13. Ensures practice addresses are current with health plans, agencies and other entities.
14. Provides necessary assistance in planning meetings, developing agendas, preparation of committee reports, and maintenance of credentials records. Processes applications for appointment and reappointment of privileges to Credentialing Committee.
15. Tracks license, DEA and professional liability expirations for appointed providers.
16. Maintains medical and clinical staff appointment files, and information in credentialing databases.
17. Audits/monitors health plan directories for current and accurate provider information.
18. Prepares departmental statistical reports as needed.
19. Assists with the maintenance of the policy and procedure manuals as they relate to the credentialing process
20. Acts as a representative for PRC at external meetings, committees, and special events as assigned.
ADDITIONAL
Responsibilities:
1. Maintains confidentiality of provider information.
2. Provides credentialing and privileging verifications.
3. Performs other duties as assigned.
Qualifications:
Education:
1. High school diploma or equivalent.
2. Associate degree preferred.
Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.
Experience: Two years of relevant credentialing experience
Training:
Maintain all PRC required training.
Skills:
1. Knowledge and understanding of the credentialing process normally acquired through 1 to 2 years experience in or related to the field of expertise.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including, letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Ability to function effectively under pressure and meet time parameters
9. Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other agency staff, clients and guests.
10. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
11. Knowledge of credentialing procedures Knowledge of English usage, spelling, grammar, and punctuation.
12. Ability to expand on own initiative in performance of duties.
13. Conforms with and supports hospital quality and improvement guidelines.
Safety Equipment
Universal Precautions
Comply with Occupational Safety and Health Administration (OSHA) rules and regulations
Life Safety Equipment (fire extinguisher)
Transportation:
Must have reliable transportation
Machines, Tool and Equipment Used:
Computer, telephone, fax, copier
Physical Requirements:
Hearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly to patients in person and over the telephone.
Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
Other: Requires occasional lifting and carrying items weighing up to 20 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular work shift.
The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
I have read the Credentialing Specialist job description and understand the functions and objectives of the position.
Employee Signature: ___________________________ Date: _________________________
Estimated Salary: $20 to $28 per hour based on qualifications.
Peace River Center
JOB DESCRIPTION
CREDENTIALING SPECIALIST
JOB TITLE: Credentialing Specialist
EFFECTIVE DATE: 2014
PROGRAM: Human Resources
REPORTS TO: Chief HR Officer
FACILITY: Main Street
CITY: Bartow, Florida
JOB STATUS: Permanent - Full time/hourly
FLSA: Non Exempt
Job
Summary:
This position is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all staff and consultants who provide patient care services at Peace River Center. The position is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities; maintaining up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
1. Responsible for maintaining and implementing the credentialing and re-credentialing process for PRC in accordance with The Joint Commission standards and other State and Federal Regulatory agencies.
2. Responsible for maintaining all credentialing functions in collaboration with other department employees to include intake, primary source verification, documentation and tracking of applications and re-applications for Medical Staff membership and clinical privileges and applications and re-applications for allied health professionals according to national quality standards
3. Participates in development and implementation of credentialing processes and procedures.
4. Compiles and maintains current and accurate data for all providers.
5. Utilizes independent judgment in determining the completeness of information prior to processing applications/reapplications. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
6. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
7. Maintains provider contract files.
8. Maintains knowledge of current health plan and agency requirements for credentialing providers.
9. Ability to reference Accreditation Manual for Hospitals of The Joint Commission on Accreditation of Healthcare Organizations and other regulatory agencies.
10. Maintains written and verbal correspondence with applicants and references regarding status of the applications/reapplications and provides appropriate follow up in deficient areas in the application.
11. Sets up and maintains provider information in online credentialing databases and systems.
12. Tracks license and certification expirations for all providers to ensure timely renewals.
13. Ensures practice addresses are current with health plans, agencies and other entities.
14. Provides necessary assistance in planning meetings, developing agendas, preparation of committee reports, and maintenance of credentials records. Processes applications for appointment and reappointment of privileges to Credentialing Committee.
15. Tracks license, DEA and professional liability expirations for appointed providers.
16. Maintains medical and clinical staff appointment files, and information in credentialing databases.
17. Audits/monitors health plan directories for current and accurate provider information.
18. Prepares departmental statistical reports as needed.
19. Assists with the maintenance of the policy and procedure manuals as they relate to the credentialing process
20. Acts as a representative for PRC at external meetings, committees, and special events as assigned.
ADDITIONAL
Responsibilities:
1. Maintains confidentiality of provider information.
2. Provides credentialing and privileging verifications.
3. Performs other duties as assigned.
Qualifications:
Education:
1. High school diploma or equivalent.
2. Associate degree preferred.
Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.
Experience: Two years of relevant credentialing experience
Training:
Maintain all PRC required training.
Skills:
1. Knowledge and understanding of the credentialing process normally acquired through 1 to 2 years experience in or related to the field of expertise.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including, letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Ability to function effectively under pressure and meet time parameters
9. Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other agency staff, clients and guests.
10. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
11. Knowledge of credentialing procedures Knowledge of English usage, spelling, grammar, and punctuation.
12. Ability to expand on own initiative in performance of duties.
13. Conforms with and supports hospital quality and improvement guidelines.
Safety Equipment
Universal Precautions
Comply with Occupational Safety and Health Administration (OSHA) rules and regulations
Life Safety Equipment (fire extinguisher)
Transportation:
Must have reliable transportation
Machines, Tool and Equipment Used:
Computer, telephone, fax, copier
Physical Requirements:
Hearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly to patients in person and over the telephone.
Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
Other: Requires occasional lifting and carrying items weighing up to 20 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular work shift.
The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
I have read the Credentialing Specialist job description and understand the functions and objectives of the position.
Employee Signature: ___________________________ Date: _________________________
Estimated Salary: $20 to $28 per hour based on qualifications.
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