Credentialing Specialist Job at Parkland Health and Hospital System
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
Primary Purpose
Credentialing Specialist supports the credentialing program that implements federal, state, and local regulatory and TJC/NCQA accreditation requirements. Ensures that all practitioners are evaluated and credentialed upon application to Membership and/or Privileges to Parkland Health & Hospital System Medical Staff or non-medical staff. Gathers, analyzes, and report provider data for the provider directory, ongoing reviews, billing needs, and member support. Communicates with practitioners and practitioner groups to answer their questions and concerns or direct to the proper department. Assists with oversight audits of Practitioners.
Minimum Specifications
Education
- Some College preferred
Experience
- Managed care or credentialing experience preferred.
- Experience with TSCA, TJC, NCQA accreditation, National Provider Data Bank (NPDB) is preferred.
- Experience with federal, state and/or local managed care statutes is preferred.
Certification/Registration/Licensure
- Prefer certification by the National Association Medical Staff Services (NAMSS).
Skills or Special Abilities
- Working knowledge of general office practices and software applications (MS Office) and database management.
- Demonstrated understanding of credentialing policies and procedures and training program requirements, as well as accreditation and regulatory requirements relating to the medical staff, specifically Joint Commission and NCQA.
- Organizational skills required to handle voluminous influx of credentialing applications and to prioritize tasks to work efficiently and meet cyclical and multiple deadlines.
- Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision.
- Analytical skills necessary to determine whether correct and complete information was provided on applications. Meticulous attention to detail.
- Interacts with diverse groups of people within the Health System and with outside agencies.
- Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies.
- Handles sensitive and confidential situations/information, with a high degree of tact and diplomacy.
- Effective interpersonal skills and demonstrated written and verbal communication skills are necessary to interact with providers and both external and internal customers.
- Skilled in interpreting, analyzing, and providing recommendations regarding data accuracy and data collection needs and processes.
- Excellent planning, organization, time management, and documentation skills.
Responsibilities
- Builds and maintains relationships with internal, and external credentialing partners including physicians and hospital leadership.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
- May conduct primary source verification for initial/re-credentialing applications in accordance with defined workflows and established policies and procedures.
- Responsible for the follow-up on missing data and/or discrepancies in accordance with established time frames and based on knowledge of general credential processes and needs of clinical assignment.
- As responses to queries received and information entered in database, compares information received with information provided by applicant to ensure accuracy and completeness.
- Imports all applications from the online application portal in accordance with policy for data standardization.
- Maintains integrity of the credentialing database and all practitioner records. Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of imported data as well as data that may be entered manually.
- Serves as a liaison with MSH affiliates and their medical staff administration departments, MMG and MFC, which includes providing effective and timely communication as the status of the application and any issues that may be identified.
- Other duties as assigned.
Job Accountabilities
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
- Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.
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