Credentialing Specialist

NueHealth•Limerick Township, PA

20h

About The Position

Under the general supervision of the Director of Quality and the Administrator this role will be responsible for the coordination, administration, and quality controls of the initial credentialing and privileging processes for all the medical staff. Assignments are planned and executed with considerable independence in compliance with established policies and procedures, bylaws, regulations, and laws. In collaboration with the Director of Quality and the Administrator, provides consultation to facilities for ongoing facility reappointment and credentialing processes.

Requirements

A minimum of three years of experience in managing medical provider credentialing and privileging processes
Knowledge of credentialing and privileging principles, processes, procedures, and documentation
Proficient in computer applications (Windows, Microsoft Office)
Able to communicate effectively both verbally and in writing. Excellent information research skills.

Responsibilities

Prepares, reviews and screens initial medical staff, allied health, new employees and contracted staff credentialing applications for completeness, accuracy, and appropriateness per policy
Performs external research and conducts verification of all initial applicants
Utilizing company policies and tools to provide facility guidance relative to the credentialing and privileging processes.
Stays abreast of and applies knowledge of applicable federal and state laws and regulations and accreditation standards. Recommends pertinent updates and revisions to policies and procedures.
Maintains the Clinical Services Program Policies and Procedures including revisions and updates
Manages the distribution and update of Clinical Services Policies and Procedures
Maintains an electronic achieve of Clinical Services Policies and Procedures
Provides documentation for surgical and special procedure patients
Maintains current materials for patient education and consent procedures
Discusses documentation with patient and family member confirming that instructions are understood, and questions answered
Answer’s patient and family member questions and refers questions to healthcare professionals when appropriate
Communicates pertinent information from the physician, support staff, insurance companies and other significant parties to the patient
Reports regularly to the Director of Quality about the status of current projects or workflow
Reviews prequalification for third party payer before date of scheduled admission
Counsels patients about Facility charges, insurance coverage and the intra-operative experience
Bills and follows-up with third party payers and patients for services received in accordance with Facility Policy and Procedures
Accurately prepares the schedule for timely distribution