Credentialing Specialist
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Department: Administration Job Status: Full Time
FLSA Status: Non-Exempt Reports To: Credentialing Manager
Grade/Level: Amount of Travel Required: >15%
Work Schedule: Positions Supervised: None
8 a.m. to 5:30 pm Monday- Thursday.
8 a.m. to 12:00 pm on Friday.
However, adjustments in schedule or additional hours may be required to complete duties.
POSITION DESCRIPTION:
The Credentialing Specialist assists the Credentialing Manager with all insurance credentialing and re-credentialing for all providers and clinics. The Credentialing Specialist should be honest and follow all insurance, state, and federal rules and laws. The Credentialing Specialist is involved in continuous Quality Improvement practices and measures as set by Mainline Health Systems, Inc. and in which the practice focus is based on a Patient Centered Medical Home model of care. These practices and measures are given to the Credentialing Specialist by the Chief Quality Officer.
SPECIFIC DUTIES AND RESPONSIBILITIES:
- Responsible for the initial credentialing and re-credentialing of all clinic locations.
- Responsible for the initial credentialing and re-credentialing of all providers for the healthcare organization.
- Responsible for maintaining accurate records of all credentialing applications with initial dates and renewal dates.
- Assists with Medical Record Requests as needed.
- Required to complete HIPAA training annually that specifically relates to medical records requests.
- Business-related travel as required.
- Participates in quality improvement practices.
- Act as additional administrative support to the care team; supporting the implementation of workflows that sustain MHSI Patient Centered Medical Home model of care.
- Willingness to attend and/or complete continuing education related to this position and/or any other topics as deemed necessary to MHSI.
- Completion of continual job training processes set forth by Mainline Health Systems, Inc.
- Performs other duties as directed by the Credentialing Manager.
REPORTING RELATIONSHIPS:
The Credentialing Specialist reports to the Credentialing Manager.
EVALUATION:
The evaluation of work performance will be ongoing and will be completed by the Credentialing Manager. It will include the specific duties and responsibilities of this position description plus employee ability to interact constructively with clinical and administrative staff and general working behavior. Formal evaluation will be conducted annually but may be initiated at other times by the Credentialing Manager.
PHYSICAL DEMANDS
Physical Demands | Lift/Carry | |||||||||||||||||||||||||||||||
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Push/Pull | ||||||||||||||||||||||||||||||||
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N (Not Applicable) | Activity is not applicable to this occupation. | |||||||||||||||||||||||||||||||
O (Occasionally) | Occupation requires this activity up to 33% of the time (0 - 2.5+ hrs/day) | |||||||||||||||||||||||||||||||
F (Frequently) | Occupation requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day) | |||||||||||||||||||||||||||||||
C (Constantly) | Occupation requires this activity more than 66% of the time (5.5+ hrs/day) | |||||||||||||||||||||||||||||||
Other Physical Requirements
Vision (Near, Color)
Sense of Sound (telephone and verbal conversations)
Sense of Touch
QUALIFICATIONS:
- A Bachelor degree preferred and High School Diploma required.
- Two years of experience in health care setting preferred.
- Working knowledge of total quality management concepts, statistical tools, and continuous quality improvement techniques.
- Experience with the reporting and operating requirements of primary care programs funded by HRSA.
- Any equivalent combination or experience and education
STATUS:
This is a FLSA Non-Exempt position.
This is an OSHA low risk position.
This is an ADA negotiable position.
DISCLAIMER
The duties and responsibilities, qualifications, physical conditions and other statements contained herein represent the current general nature of the job described, and are subject to change at any time, with or without notice. This job description does not limit in any way the assignments that may be given to an employee in the job, and employees are expected to perform any and all duties assigned by their supervisor willingly and without reservation.