Credentialing specialist job description

Children's Hospital of New Orleans is a leader in Pediatric care throughout the Southeast region. We are seeking a dynamic Credentialing Specialist. The mission of making care available to all children has allowed Children's to grow as an organization. Children's Hospital is a not-for-profit medical center offering the most advanced pediatric care for children from birth to 21 years. With over 40 pediatric specialties and more than 400 physicians, it is the only full-service hospital exclusively for children in Louisiana and the Gulf South. We invite you to experience the magic of Children's Hospital.

Position Summary: The Credentialing Specialist will process payer enrollment and credentialing for all medical staff providers with insurance payers. The Credentialing Specialist will also assist with processing medical staff credentialing and privileging medical staff providers as needed and/or directed.
Job Specifications:

Education: Minimum Required: High School Diploma or equivalent Preferred: BA/BS degree in business or related field

Experience: Minimum Required: 2-3 Years administrative secretarial skills Preferred: 1-3 years in insurance enrollment, payer credentialing, billing/central business office and/or medical staff office

License/Certification: Preferred: CPCS/CPMSM

Special Skills/Training: Minimum Required: -Input data accurately into appropriate system and maintain records/database to ensure up-to-date information. -Excellent oranizational skills; oral and written skills -Ability to follow-up on pending items; critical thinking. -Abilbity to act independently and ability to maintain confidentiality. -Competency in Microsoft Office, specifically Excel, Outlook, PowerPoint, Word. Preferred: -Knowledge and experience working with insurance payers -Ability to take and transcribe minutes.

As a member of our team, you will not only experience personal reward, you will also find tangible benefits for you and your family. For more information please go to www.chnola.org. Children's Hospital is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, or status as a qualified individual with disability.

The Credentialing Specialist provides support for the department. This position performs a variety of confidential administrative and credentialing functions for the medical staff. This position initiates and follows through on the appointment/change in status process for the medical staff and allied health professionals.Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization is a proud a member of the Mayo Clinic Care Network and includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida. "Processes all initial and temporary privilege applications for Medical Staff and Allied Health Professional clinical privileges to meet Baptist Hospital, Inc., Medical Staff Bylaws, Rules and Regulations and The Joint Commission accreditation standards. Interfaces effectively with Medical Staff leaders, office managers, etc., to ensure timely completion of all medical staff applications. Submits completed credentialing materials flagging any concerns for the initial appointment application to Manager, Medical Affairs. Assists with the routing process, as needed. Maintains up-to-date physician database systems, maintenance and monitoring accuracy, including monthly reports to hospital personnel and documenting compliance with OIG and Board Certifications. Completes monthly follow-up process within 3 - 5 working days. Assist Manager, Medical Affairs with special projects including preparation for Bylaw Revision Project, and regulatory compliance projects. Assists the department manager with projects as assigned and performs other duties when necessary in conjunction with the department manager.Assist in other duties as assigned to support the operational needs of the department and organization. May be required to remain on campus immediately before, during, and after severe weather and/or disasters."
+ High School Diploma or General Education Degree required, some college preferred

+ Experience in health care related field preferred.

+ CPCS or CPMSM preferred.

+ Proficiency in word processing, Excel and database system updating. Maturity, initiative, strong computer skills and flexibility are critical to this position.

+ Individual who is highly organized, detail oriented and able to handle multitude tasks

+ Excellent interpersonal skills

+ Excellent verbal/written skills, including accurate and concise minute and report presentation skills

+ Knowledge of Joint Commission, federal and state regulations

+ Medical terminology knowledge

What You Will Do:

Functions under the general oversight of the department director. Critically evaluates credentialing and privileging information to identify potential performance issues. Maintains open communication with Medical Staff leaders and facilitates communication with all privileged practitioners.

ESSENTIAL FUNCTIONS OF THE JOB:

1. Applies critical thinking skills in evaluating all credentialing and privilege information to identify potential performance issues.*2. Collaborates with the director and Chief Medical Officer to determine actions necessary to resolve issues.*3. Meets with Medical Staff leaders to review credentialing and privileging information and advise the leaders on actions taken or options available to address any issues with a credentialing or privileging request.*4. Maintains knowledge of current credentialing and privileging requirements of the Centers for Medicare and Medicaid Services, The JointCommission, and the National Committee for Quality Assurance; assuring all credentialing and privileging processes are compliant with those expectations.5. Maintains the master copies of privilege forms for the Medical staff, drafting revisions as directed by Medical Staff Committees.6. Maintains the master copies of Innovative Health Services policies, and appointment/reappointment applications; drafts revisions to those documents in collaboration with the Director of Innovative Health Services.7. Serves as a database administrator for credentialing software including:*• Assuring data integrity• Generating reports as requested• Collaborating with vendor on revisions to documents and processes as well as troubleshooting issues with software applications (online affiliation verifications, Intranet privilege lists, electronic application)8. Supervises the Credentials Assistant to assure all required information is collected to meet organizational timelines.*9. Coordinates orientation of newly privileged practitioners.10. Manages information flow from Medical Staff committees to the Medical Executive Committees and the Shore Regional Health Board of Directors by• Directly supporting the Shore Health Credentials and Bylaws Committee and Medical Executive Committees• Collaborating on the development of the packet and plan for the Chester River Credentials Committee and Medical Executive Committee• Submitting information from the Medical Executive Committees for use by the Patient Quality and Safety Committee and the Shore Regional Health Board of Directors.11. Directly supports the Innovative Health Services committees as assigned.12. Supports communication of information from the Medical Staff Office to the members of the Medical Staff through the dissemination of e-mail and paper notifications.*13. Strives to achieve excellence of service as described in the CARE Commitments.14. Responds to Shore Regional Health codes as appropriate.15. Responsible for honest behavior in all matters. To the best of the employee's knowledge and understanding, complies with all Federal and State laws and regulations.16. Maintains the privacy and security of all confidential and protected health information. Uses and discloses only that information that is necessary to perform the function of the job.17. Performs related duties as assigned.

*Essential job duties

Must be willing to travel between facilities.

What You Need to Be Successful:

High School diploma; minimum of five (5) years of experience in medical staff credentialing or clerical experience; Associate degree preferred. Knowledge of medical terminology is preferred. Demonstrated excellent verbal and written communication, interpersonal and organizational skills. Must be fluent in Microsoft Office computer software.We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.