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Credentialing Specialist
This position is: Full Time
Position Location: Lake Charles, LA

Essential Function: The Credentialing Specialist assists the Credentialing Coordinator with maintaining pertinent credentialing information for each of the practitioners at Imperial Health to ensure that partners and mid-level providers continuously meet the credentials, standards, and requirements of hospitals, entities and healthcare networks and performs designated medical record functions.

Supervision: Supervised by Credentialing Coordinator

Job Responsibilities:

Maintenance of Provider Master Log Spreadsheet

Licensure

PPD and Flu Vaccinations or Declinations (annual)

Board Certification

BLS/ACLS Certification

Maintenance of Facility Affiliations

Maintenance of Facility Spreadsheet

Initial privilege applications

Renewal of staff privileges when due

Providing facilities with renewed licensure for privileged providers

Maintenance of CAQH/Proview Database

Updates and attest each time licensure, certification, etc. changed

Maintenance of Access Radiology Provider Files

Maintains provider log with renewed/updated information issued by Radiology Department

Ensures contracted Radiologists have active licensure and MP coverage at all times

Maintenance of OneApp Pro Database

Loads new providers into database and maintains database for accuracy

Updates existing providers information when renewed

Medical Licensure and Certifications

Completes Renewals of Medical Licensing, including CDS (Controlled Dangerous Substances) and DEA (Drug Enforcement Agency), on the physician's behalf

Coordinates renewal process with mid-level providers

Monitors expiration dates of Board Certifications, ACLS, etc. and sending reminders when necessary

Medical Records:

Works with Medical Records vendor to scan Medical Records releases into Centricity weekly

Assists with Medical Record retrieval upon request from authorized individuals (e.g. stored charts, litigation claims)

Processes paper records requests for HEDIS and Risk Adjustment reviews

Coordinates onsite visits for record auditors

Prepares secure access for auditors who need to review Electronic Medical Records and ensures that access is limited to specific patient charts (Insurance, Tumor Registry etc.)

Maintains a file containing auditor request logs for reference

Other duties as assigned

Qualifications: Must be able to work independently with minimal supervision. Must possess excellent discretionary judgment and good organizational skills as well as excellent verbal and written communication skills. Must be able to work with sensitive information in a professional and confidential manner. Must be able to relay information accurately in telephone conversations, messages, email, and other forms of communication. Must have working knowledge of MS Word and Excel.

KNOWLEDGE, SKILLS & ABILITIES:

  • Must possess strong organizational and communication skills
  • Able to meet deadlines
  • Work well under pressure
  • Ability to promote teamwork

EDUCATION REQUIREMENTS:

Minimum high school diploma or equivalent with experience as listed below.

EXPERIENCE:

  • Minimum of 2 years of Business Office/Administrative experience in a medical office/facility setting or
  • Minimum of (3) years of advanced clerical experience in a professional office setting

ENVIRONMENTAL/WORKING CONDITIONS: Office setting. Frequent telephone calls and other interruptions, which requires being able to handle a fast-paced work environment during entire time at work. Must be able to prioritize multiple projects. Must maintain strict confidentiality and exercise professionalism when interacting with staff, managers, supervisors, physicians, external customers, etc.

 

PHYSICAL/MENTAL DEMANDS: requires continuous standing, sitting, frequent walking, bending, and stooping. May require lifting 50 to 100 pounds. Exposure to possible Hazardous Materials/conditions and infectious diseases.


 

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