Ethan Frome - NAMSS



CENTRACARE CLINIC - RIVER CAMPUS

POSITION TITLE: Credentialing Specialist DATE: 8/26/2009

DEPARTMENT: Business Office

ACCOUNTABLE TO: Business Office Coordinator

APPROVALS:

EMPLOYMENT/SELECTION CRITERIA (Knowledge, experience, education, and skills required):

1. Graduate of a post-high school business or healthcare program or 2-3 years experience in medical credentialing.

2. NAMSS Certification as CPCS preferred.

3. Possess the ability to type accurately and efficiently.

4. Possess strong computer skills including Microsoft Office products and Outlook.

5. Medical background and previous physician credentialing experience preferred.

6. Ability to interact with patients, physicians, and employees in a courteous and professional manner.

7. Ability to be flexible and responsive to frequent work schedule changes to include number of hours of work per day, starting, and ending times and short notice work schedule changes.

7. Must possess strong organizational skills, problem solving skills, be detail orientated, and work independently. Ability to multi-task to meet appropriate deadlines.

8. Must possess interpersonal, verbal, and written communication skills.

POSITION SUMMARY STATEMENT:

The Credentialing Specialist performs credentialing duties for CentraCare Clinic providers, and others facilities as requested by Executive Administrator.

EXTERNAL INTERFACE:

Administrators, Clinic Coordinators/managers, St Cloud Hospital staff, medical and support staff from other health care facilities, insurance companies, and vendors.

INTERNAL INTERFACE:

All staff and physicians.

MAJOR AREAS OF ACCOUNTABILITY (ESSENTIAL JOB FUNCTIONS):

1. Facilitates current staff privilege applications for providers at their primary hospital for the initial and subsequent credential phases. Processes initial applications and reappointments for outreach sites.

2. Collects accurate information to support Credential database. Process initial and re-credential applications, provider demographic change requests, address changes/corrections on all CCC providers. Responsible for assuring applications are processed in accordance with NCQA/JC/CMS standards. State and federal regulations and criteria outlined by payers.

3. Maintains current liability insurance certificates for providers. Insures that copies and changes are sent to all third party payers and facilities where the individual provider maintains privileges.

4. Facilitates credentialing process for new providers beginning practice with CCC. Completes all provider application forms and applications for hospital privileges. Monitors Minnesota medical license, DEA application process, board certification process and assures timely completion.

5. Notifies administrative personnel, to initiate orientation process, ordering lab coats, pagers, and cell phones.

6. Responsible for proofreading all third party payor provider directories.

7. Maintains and keeps current the Credentialing Procedures Manual.

8. Coordinates physician CME subscriptions and conference registrations with accounts payable. Maintains CME tracking, assures providers forward CME documentation, and assures required credits to support medical license renewal and hospital privileges are maintained by provider.

9. Maintains corporate, credential, outreach, CME, and licensure files for all providers.

10. Processes annual renewal of providers’ medical licenses and informs physicians of current CME status on an annual basis at the time of renewal. Forwards copy to all facilities where the individual provider maintains privileges.

11. Maintains current DEA registration for providers. Forwards copy to all facilities where the individual provider maintains privileges.

12. Maintains and distributes the physician provider ID list

13. Provides backup to other Business Office Supervisors and Business Office Coordinator

14. Schedules conference rooms upon request.

15. Assures providers maintain Board Certifications.

16. Assures that providers maintain Life Support Certification if required for their specialty.

17. Annually evaluates physicians' CV’s and updates as appropriate.

18. Performs miscellaneous duties and projects as assigned.

19. Continuously evaluates essential job functions and seeks to improve efficiency of these duties by streamlining duties/identifying better methods to accomplish the duties.

20. Takes a proactive approach in patient safety issues by informing immediate supervisor or the Quality Improvement Department of any potential or actual patient safety issues.

21. Good attendance is necessary to assure support is readily available to administrative staff on a consistent basis.

WORK ENVIRONMENT CONDITIONS:

Normal Office Environment:

Indoors in a clean and well illuminated area of constant temperature in which one is exposed to only noise from business machines and no additional protective measures are necessary.

A. Bloodborne Pathogen Exposure Potential:

Category III

Tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment.

The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon to perform or assist in emergency medical care of first aid or to be potentially exposed in some other way. Tasks that involve handling of implements or utensils use of public or shared bathroom facilities or telephones, and personal contacts such as handshaking are Category III tasks.

B. Hazardous Substance Exposure Potential:

Exposure as defined in the MSDS manual.

EQUIPMENT USED (Office equipment, machinery, tools, software, etc.)

Computer, copier, fax machine, calculator, and telephone.

PHYSICAL & MENTAL REQUIREMENTS (as presently performed to accomplish the essential job functions)

1. Ability to lift and/or carry objects up to 20 lbs.

2. Must have the ability to sit for several hours at a time.

3. Ability to concentrate and maintain accuracy in spite of frequent interruptions.

4. Ability to be courteous, tactful, and cooperative throughout the day.

5. Ability to stand, bend, stoop, carry light loads, walk throughout the day.

6. Ability to maintain confidentiality with regard to all phases of work.

7. Acute visual and auditory senses.

8. Ability to communicate clearly in English in both oral and written forms of expression.

Interested applicants can apply online at

l:\human resource directory\job descriptions\administration\admin asst-cred spec.doc 05/10/2002

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