Sr. Credentialing Specialist

About the Role

This position collaborates with a third-party/external credentialing agent to ensure the credentialing process is completed as required for FMCNA locations. The role ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards, as well as internal FMCNA policy and procedure.

Performs audits of both the internal FMCNA Provider Database and FMCNA provider information compiled by the external credential verification agent to ensure timely completion of credential verification according to all regulatory and company requirements.

Responsibilities

• Performs provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff bylaws regarding verification of a practitioner's credentials prior to the patient receiving their second treatment.
• Handles tasks related to the three-year cyclical verification process of all active practitioners.
• Utilizes knowledge of national accreditation standards, internal medical staff bylaws, and related policies to perform functions pertaining to the provider/practitioner credentialing process, including:
  • Obtaining practitioner license information from publicly available state/government agency websites, the National Provider Databank, and other third-party certification groups such as the American Board of Internal Medicine.
  • Completing and processing all initial credential applications for new providers/practitioners and credential verification applications for existing providers/practitioners in a timely and accurate manner.
  • Conducting follow-up as needed, acting as the primary liaison for FMCNA locations, practitioners, and the FMCNA third-party credentialing agent to ensure timely completion of credentialing and compliance with federal, state, and FMCNA requirements.
  • Maintaining and updating the database on individual provider/practitioner credentials' status, tracking pending/completed applications, and ensuring a complete and accurate historical record.
• Provides regular reports and updates to FMS field operations management and the Director of Operations Monitoring.
• Communicates with practitioners regarding credentialing status, providing updates, and obtaining additional information as required.
• Educates and informs FMS field staff responsible for reporting new practitioners about their responsibilities in the credential verification process, including credentialing requirements, practitioner-specific information, and industry standards.
• Continually audits and analyzes the credentialing process to identify deficiencies in controls and workflow issues, recommending improvements to management and implementing them if approved.
• Reviews internal Provider Database information and the database compiled by the external credential verification agent to identify and correct areas of noncompliance with company policy.
• Generates various standard and ad-hoc reports from the database, including:
  • Project status reports detailing the progress of credential verification for individual practitioner applications.
  • Reports on credential verification issues for pertinent field staff and the credential verification agent.
  • Monthly provider/practitioner credentialing status reports for review by the Director of Operations Monitoring.
• Reviews and complies with the Code of Business Conduct and all applicable company policies, local, state, and federal laws and regulations.
• Assists with various projects as assigned by a direct supervisor.
• Performs other duties as assigned.

Requirements

• Bachelor’s Degree required.
• 0 - 2 years of related experience.
• Strong detail orientation with the ability to administer multiple tasks and prioritize effectively.
• Excellent verbal and written communication skills.
• Ability to positively interact with providers, hospital personnel, and other internal and external contacts.
• High level of accuracy and adherence to timelines.
• Attention to confidentiality and protection of sensitive information.
• Advanced skills in Microsoft Access, Excel, and Word.
• Strong problem-solving and time management skills, with the ability to work in a fast-paced environment.
• Strong database management, document storage, and data management skills.