Credentialing Specialist II

About the role

Do you want to join an organization that invests in you as a Credentialing Specialist II? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team over the course of three years. Candidate must live within 60 miles of a HCA facility in FL, GA, ID, KS, KY, MO, NC, NH, NV, SC, TN, TX, UT and VA.

Responsibilities

• Master communication and regulatory guidelines, policies, procedures, and internal systems, coupled with keen insight into practitioner 350+ internal customers, plus external customers.
• Forge collaborative partnerships with over 350+ healthcare facilities, customers, and stakeholders.
• Master competency and acquire extensive experience through review of Data Integrity Reviews, Specialist Reviews, and Compliance Reviews, supporting precise accurate identification of potential practitioner issues and flagging of practitioner risk.
• Adhere to stringent regulatory guidelines, Joint Commission Standards, Facility Bylaws and CPC standards.
• Ensure the flawless, timely, and accurate credentialing of medical and allied healthcare providers, upholding the highest standards of quality.
• Discern, identify and escalate practitioner risk concerns by utilizing policies, procedures, verification elements, or regulatory guidelines as validation.
• Identify and analyze potential compliance flags and collaborate with practitioners on sensitive issues and external organizations (e.g., drug addiction centers, anger management centers) to accurately document or resolve confidential practitioner issues.
• Meticulously document resolution and/or unresolved complex issues and escalations in practitioner files that may support future lawsuits.
• Contribute valuable insight into the strategic development and implementation of policy frameworks and participate in comprehensive audits, ensuring regulatory adherence.
• Provide strategic counsel to Managers and Directors regarding ambiguous information, and escalate critical issues identified during credentialing processes with expediency and precision.
• Maintain meticulous credentialing records, guaranteeing accurate scanning and secure storage of all correspondence within mandated timeframes.
• Uphold unwavering compliance with all governing policies, procedures, and Federal and State regulatory and accrediting agency requirements.

Qualifications

• Associate’s degree or equivalent work experience. Bachelor’s degree preferred.
• 5+ years’ experience in healthcare credentialing with Parallon or HCA required.
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance, preferred.
• Detailed working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred.
• NAMSS Certification preferred.
• Remote employees are required to live within 60 miles of an HCA hospital.
• Remote employees are required to have wired (Cable or fiber) internet access with 25 Mbps Download and 15 Mbps Upload.

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.

Schedule

Monday-Friday, 32 Hours between 9:30AM-6:00PM CST