April, 2015 - Credentialing Specialist - Questcare

Dallas-based medical practice management firm seeks a full-time Credentialing Specialist.  The position will be responsible for the coordination and implementation of the provider enrollment and provider credentialing and recredentialing processes including but not limited to initiating the paperwork, obtaining documentation and signatures and ensuring timely submission of applications for processing. Primary point of contact for physician and allied health providers. Reviews applications for accuracy and completeness. Ensure timely communication. Serves as liaison between provider and medical staff organization. Primary point of contact for billing vendors to ensure immediate processing of provider enrollment applications. Updates and maintains current provider credentialing files and providers up to date credentials to hospitals and billing vendors. Performs all functions in a courteous and professional manner.

Position Qualifications

A. Education, Certification and Experience

* Four year Bachelor’s degree in health services administration or related field, or equivalent experience

* One to five years of credentialing experience in a physician group organization or health system

B. Specific Knowledge, Skills and Abilities

* Working knowledge of credentialing principles for provider hospital privileging and credentialing.

* Strong organization and time management

* Strong attention to detail

* Ability to work collaboratively, exercise reliable judgment and problem solve.

* Written and verbal communication skills

* Ability to react effectively to unplanned circumstances, demands and challenges.

* Ability to function in a fast-paced, high-pressured environment.

* Ability to meet deadlines under extreme pressure

* Ability to work a flexible work schedule

* Ability to work occasional long or irregular hours

* Ability to interact effectively with staff, employees, supervisors, managers, physicians, and hospital executives

* Intermediate computer skills; ability to generate reports, documents and correspondence independently.

* Current working knowledge of Joint Commission, NCQA and Medicare credentialing standards and other regulatory requirements.

* Strong knowledge of medical terminology.

* Experience using credentialing management software.

Job Responsibilities

* Demonstrates organization’s core values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork.

* Administers all credentialing and provider enrollment application process operations, including but not limited to:

o Prepares/Mails provider enrollment, initial and re-credentialing applications

o Reviews applications for accuracy and completion

o Ensures the provider meets the qualifications per hospital bylaws.

o Provider application data entry into credentialing software

o Obtains primary source verifications in accordance with NCQA standards

o Maintain status completion list for all assigned applications

o Requests additional information and clarifications as necessary

o Collect all supporting documents necessary to complete the provider enrollment, credentialing and assessment of provider competency.

o Serves as liaison between the Medical Staff Office and provider to ensure the application is presented to the credentialing meetings in a timely manner.

* Assists provider with obtaining state medical license, state narcotic license, and Federal DEA license.

* Responsible for expiration notices, obtaining updated credentialing documents (state license, state narcotic license, federal DEA license, vaccines, board certifications, life support certifications) and submitting to appropriate entities to keep provider profile up to date.

* Work with client’s billing vendors by providing completed provider enrollment applications and supporting documents as requested.

* Maintains current knowledge of client’s Bylaws, policies and procedures, Joint Commission and NCQA accrediting standards as well as state and federal regulatory requirements. Provides appropriate interpretation and clarification of standards and requirements.

* Maintains confidentiality at all times.

* Performs other work-related duties as necessary

Please forward resume with salary request to jobs@qrxmed.com