· Broad base of understanding, integration and application of BUHMC — Credentialing policies and procedures.
· Accurate review of provider application or reappointment application packet for completeness and accuracy for the timely submission to the Credentialing Committee and subsequent venues for provider appointment to meet regulatory, insurance and organizational requirements.
· Knowledge of and implementation of NCQA standards for participation and preparation of physician files for audits.
· Collects, verifies and ascertains information needed for processing new applications, reappointments, temporary privileges, etc.
· Accurate input of initial and ongoing data elements recorded in the credentialing software system.
· Completion of Credentialing Checklist as operational control for internal credentialing processes.
· Creates and maintains accurate logs for mail, new applications, re-appointments and system generated letters and tracks progress of same.
· Responds to inquiries for physician verification in an accurate and timely manner.
· Facilitation in the depth investigation and documentation required for remediation and management of "red flags issues for Credentialing Committee determination / appropriate follow through.
· Collection of required documentation with respect to the Delineation of Privileges for new appointments to the Medical Staff.
· Recognition of data verification triggers and conducts data validation as needed.
· Facilitate enrollment, communications and reporting for the enrollment of providers with third party insurers.
· Recognition of data verification triggers; conducting data validation — data integrity efforts on as needed basis
· Develop and distribute ad hoc report requests as requested.
· Self-directed, Independent organization of work efforts with a high degree of accuracy.
· Demonstrates ability to prioritize work and meet deadlines.
· Participates in the Department's performance improvement activities.
· Maintains patient/employee confidentiality in the management of information.
· Perform other duties when necessary.
· College degree preferred or an equivalent of education plus relevant experience in a healthcare environment.
· Minimum three (3) years of related experience in a healthcare setting.
· Cactus Credentialing System.
Knowledge and Skills:
· Excellent interpersonal and communication skills required.
· Ability to prioritize work in an environment with multiple interests.
· Ability to work independently with minimal supervision.
· Ability to handle complex and confidential information with discretion.
· Competency using a variety of computer software.
· Certified Provider Credentialing Specialist - CPCS preferred.
· Position requires prolonged periods of sitting and use of a computer and screen viewing throughout the working day.