HCA - Part Time Credentialing Specialist

Responsibilities

• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy and procedure
• Absorb responsibility for credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review
• Assist in the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes
• Acts as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to clients in a timely manner
• Process and maintain credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations
• Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure
• Monitor collection of all information received; follow up on missing items and/or incomplete forms per CPC policy and procedure, submit follow up requests for verifications as needed
• Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response

Qualifications

• Associate degree or an equivalent combination of education and experience required. Bachelor's degree preferred.
• Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care setting, credentials verification organization, or Medical Staff Office)
• Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
• Demonstrated working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
• Completion of post Cactus training testing of 85% or greater
• Understanding of professional telephone etiquette
• Able to work with minimal supervision and works well in both individual and group environment
• Certified at CPCS level preferred, or a commitment to pursue certification within one year