Credentialing Specialist

Credentialing Specialist

Full Time Clerical

Spokane Valley, WA, US
POTENTIAL WORK FROM HOME OPPORTUNITY
Apply for Credentialing Specialist using the link below:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=295195fd-01e3-48ce-9e51-b3a7584950e9&ccId=19000101_000001&jobId=316224&lang=en_US&source=CC4

 

 

General Summary: This position is accountable for data collection, organization and submission of applications required by health plans, hospitals and governmental and other regulatory agencies. Works closely with individual practitioners, organizational leadership, Affiliated Hospitals Medical Staff, Payer’s Provider Relations Staff, Human Resources, and Billing Department to facilitate timely hospital credentialing and privileging, payer enrollment and re-enrollment, as well as expirables (state licenses, DEA, Board Certification, malpractice insurance, etc.) as required by governmental agencies and accreditation bodies. This position will also support the organization’s Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) program, in addition to performing administrative tasks such as, meeting minutes, special projects, etc. as needed.

 

Minimum Qualifications

  1. Associates Degree or high school diploma equivalent
  2. Two – three years’ experience in provider credentialing, payer enrollment, healthcare, or general office experience
  3. Must be highly organized, motivated self-starter with impeccable attention to detail
  4. Must work with a sense of urgency and demonstrate the ability to prioritize and work effectively under pressure
  5. Possess excellent communication skills (written, presentation, listening, and oral)
  6. Proven ability to interact with physicians and support staff
  7. Evidence of ability to coordinate multiple projects and tasks of medium complexity.  Advanced proficiency in Microsoft Office programs
  8. Takes initiative and works independently with minimal guidance.  Ability to demonstrate excellent customer service
  9. Ability to demonstrate problem solving skills

Preferred Qualifications

  1. Bachelor’s Degree in Health Care Administration or equivalent
  2. Certified Provider Credentialing Specialist (CPCS) OR meet requirements to become certified within 6 months of hire
  3. Working knowledge of Joint Commission Standards, NCQA Standards, CAQH, OneHealthPort, PECOS (Medicare), AMA, PECOS and primary data source verifications.

 

Essential Job Responsibilities:

  1. Maintains Credentialing of Incyte Diagnostics’ Pathologists
  2. Maintains Payer Enrollment of Incyte Diagnostics’ Pathologists
  3. FPPE and OPPE Program Support
  4. Provides Administrative Support

 

Performance Requirements:

  1. Maintains Credentialing of Incyte Diagnostics Pathologists
  • Successfully oversees the entire hospital credentialing process through Pathologist’s onboarding (start date) and offboarding (exit date) (physician life cycle with Incyte)
  • Maintains timelines credentialing schedules, communicates with Pathologist and other departments to update as needed, clarifies information requirements with internal and external stakeholders, and maintains strict level of confidentiality to provider information.
  • Oversees the collection, tracking, verification, and maintenance of all pathologists information needed for credentialing, provider demographic updates, contracting, and other platforms as applicable. Credentialing data includes but not limited to education, post graduate training, sanctions (licensures; Medicare/Medicaid), work history, medical staff membership, peer references, NPI, NPDB monthly monitoring, licensures, DEA, Board Certification, CV, malpractice insurance, hospital privileges, activity reports and current clinical competence/ability to perform, continuing medical education (CME) and self-assessment modules (SAM), etc.
  • Ensures all Pathologists are added to Incyte’s malpractice policy
  • Perform all initial credentialing, re-credentialing, , initial and renewal for state licenses and DEA per established protocols; review for accuracy
  • Follows established workflows to ensure proper credentialing/licensing elements are submitted; perform timely follow-up
  • Monitor status of application to ensure accurate and efficient completion
  • Effectively work with Pathologists to obtain missing, incomplete and expiring information
  • Establish and maintain long-term working relationships with Pathologists to ensure good support and communication, as well as clear expectations and requirements
  • Quarterly reporting of individual and group information
      • State Licenses (Standing and Expiration)
      • DEA (Standing and Expiration)
      • Board Certification (Standing and Maintenance of Certification – MOC Cycle, if applicable)
      • Hospital Medical Staff Membership & Privileges (Standing and Expiration)
      • CME/SAM
      • Activity Report
  • Utilize advance problem solving skills to resolve issues and conflicts that may arise with support of supervisor when needed

 

  1. Payer Enrollment of Incyte Diagnostics’ Pathologists
  • Successfully oversees the entire payer enrollment process through Pathologist’s onboarding (start date) and off boarding (exit date) (physician life cycle with Incyte)
  • Maintains timelines enrollment schedules, communicates with Pathologist and other departments to update as needed, clarifies information requirements with internal and external stakeholders, and maintains strict level of confidentiality to provider information
  • Oversees the collection, tracking, verification, and maintenance of all pathologists information needed for enrollment, provider demographic updates, and payer contracting requirements. Payer Enrollment data includes but not limited to Medicare, Medicaid, private/commercial, and worker’s compensation payers electronic or paper enrollment and re-enrollment applications; licensure, certifications, and hospital affiliations; peer references & work history; practice information/description/services; malpractice and professional liability insurance information and history; billing information/clearing house/3rdparty administrators; attestation questions and disclosures; Ownership/Controlled/Interest Disclosures; information release and acknowledgements; provider agreements/EFT agreements; IRS Issued CP575 and signed/dated IRS W9; etc.
  • Perform all initial enrollment and re-enrollment applications per established protocols; review for accuracy
  • Follows established workflows to ensure proper enrollments are submitted; perform timely follow-up
  • Monitor status of application to ensure proper enrollment
  • Effectively work with Pathologists and Billing Department to obtain missing, incomplete and expiring information
  • Establish and maintain long-term working relationships with key payer staff to ensure applications are completed in an efficient and high quality manner
  • Quarterly Reporting of Payer Matric
      • Group Dashboard (% members enrolled in each payer)
      • Individual Pathologists (Enrollment – Complete, In-process, Not Enrolled)
  • Maintain current payer information including contacts, required documentation, and re-enrollment cycles

 

  1. FPPE and OPPE Program Support
  • Collate and maintain key data elements in internal databases for both FPPE and OPPE
  • Assist with the development, implementation, and documentation of QA processes
  • Provide administrative support to the committees by scheduling meetings, preparing agendas and meeting minutes

 

  1. Provides Administrative Support
  • Provides back up for production and interpretation of pathologists’ schedules, complying with corporate guidelines regarding time off, staffing, etc.; is able to determine staffing needs to resolve staffing issues, etc.
  • Provides back-up for organization and scheduling of company meetings/activities, business travel, conferences, etc.
  • Track and maintain pathologist continuing education database
  • Distributes weekly pathologist schedules appropriately and in timely manner (hard copies & Incyte Central)
  • Transcription of small hospital visit scheduling and production/distribution of reports of visit
  • Participates in company committees Provides leadership and/or assistance as needed in setting-up/announcing meetings/events, arranging rooms, refreshments, etc. Order supplies as needed.
  • Distributes agendas for assigned committee meetings; takes and distributes minutes at assigned committees.
  • Follow Incyte Diagnostics’ Standards of Conduct as described in the Employee Handbook
    • Be a productive member of Incyte’s culture
    • Be a good steward of resources

EEO Notification
Incyte Diagnostics is an EOE, including disability/vets