Credentialing Specialist

POSITION SUMMARY: Performs research, analysis and develops reports related to areas of responsibility. Provides support with record keeping, file maintenance, HRIS entry, etc. Responsible for performing activities related to applications made to the Affinia Healthcare Medical Staff, including the credentialing and privileging of medical, dental, behavioral health, and other allied health professionals for initial, provisional an reappointment , per policy.

POSITION QUALIFICATION REQUIREMENTS

Education:

Bachelor or Associate Degree preferred or any equivalent combination of experience and education.

Experience:

1. One (1) to three (3) experience in medical staff services and credentialing in a medical, academic, or hospital setting or related field with proven skills in area of medical staff and credentialing processes. (Required)
2. Three (3) to five (5) years HR experience in a generalist capacity (preferred).
3. One (1) year experience with an HRIS database (preferred).

Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:

1. High level oral and written communication skills, along with strong computer skills.
2. Must be detail oriented; strong analytical and problem solving skills.
3. Knowledge of principles and practices of HR.
4. Ability to maintain confidentiality and exhibits discretion as needed.
5. Excellent interpersonal skills; works to maintain constructive working relationships.
6. Ability to complete work in a timely, accurate, conscientious and thorough manner.
7. Commitment to maintain the confidentiality of correspondence, documents, discussions, meetings, and telephone calls.
8. Must present a demonstrated knowledge pertaining to computer and communications equipment.
9. Must have excellent time management and organizational skills.
10. Must have the ability to interact timely and effectively with internal and external customers.
11. Able to travel, represent Affinia Healthcare at job fairs, campus visits, and misc. recruiting events.

Transportation Requirement: Must possess a valid driver's license and automobile with insurance coverage as required by the State of Missouri

License(s)/Certification(s) Required: None

FUNCTIONS OF THE JOB

Essential Functions

1. Manages all provider based privileging at Affinia Healthcare and data management functions ensuring compliance with Joint Commission, National Committee of Quality Assurance (NCQA), Department of Health and Human Services (DHHS), Center of Medicaid/Medicare Services (CMS) and other regulatory standards.
2. Verifies that privileging information of professional staff and health providers are filed and maintained in database and permanent files in compliance with federal and state regulations.
3. Collaborates with medical staff, Human Resources, Compliance, Billing, etc. to ensure personnel and credentialing files are maintained and processing standards are met.
4. Provides privileging files and reports in a timely fashion to the CEO, CMO, Dental Director, and Behavioral Health Director for timely presentation to the Affinia Healthcare Board of Directors.
5. Maintains knowledge of organizational and regulatory body requirements for privileging licensed providers.
6. Create and maintain credentialing files.
7. Data entry of provider's information into the database.
8. Maintains current documentation and updates in database.
9. Verifies providers' credentials by primary source, internet and clearinghouses.
10. Obtains insurance certificates and NPDB self-queries.
11. Coordinates file review and approval by the Credentialing Committee.
12. Networks and coordinates the sharing, receipt, and/or update of information among various internal departments if requested.
13. Prepares documents as required for audits and ad hoc reports.
14. Obtains copies and/or verifications of expired documents.
15. Responsible for office supplies and department orders.
16. Oversees the processing of all reappointment applications for medical staff and health professional staff, ensuring completeness within specified timeline.
17. Maintains credentialing database, audits data periodically to ensure accuracy, and serves as super-user for troubleshooting and training users.
18. Processes requests for additional clinical privileges, medical staff status changes, and resignations.
19. Reviews all new applications for presentation to ensure completeness and accuracy of physician profile, and obtains any additional information as needed.
20. Maintains competency through professional growth and development through continuing education sessions, conferences, and seminars.
21. Maintains performance levels consistent with departmental standards.
22. Knowledgeable of all HR policies.
23. Responds to information requests, handles employment verifications and other inquiries.
24. Enters data into HRIS as needed, ensures accuracy, and produce needed reports.
25. Performs other duties as assigned.

Marginal Functions

1. Attend organizational meetings as needed

Supervises: None

NOTE: Affinia Healthcare is a Covid-19 Vaccine Mandated Employer. All employees of Affinia Healthcare are required to be vaccinated for Covid-19.

NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT

NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES

AN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS

Current Openings for Credentialing Specialist Jobs at Affinia Healthcare