Processing initial credentialing and re-credentialing applications
Screening practitioners’ applications and supporting documentation to ascertain their eligibility
Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer
Collecting primary source credentialing and privileging verification, via AMA, AOA, ECFMG, OIG Exclusions List, Licensing Board, DEA and OBNDD verification, National Student Clearinghouse, Board Certifications
Identifying discrepancies in information and conducting follow up
Assist Credentialing Specialist to present completed initial and re-appointment credentialing applications to the Credentialing Committee
Present completed initial and re-appointment credentialing applications at monthly Health Board Meeting
Distribution, research and working knowledge of Medical Staff Bylaws, Rules and Regulations. Assist with the development of the Medical Staff Bylaws, policies, procedures, rules and regulations to ensure that the medical staff is aware of changes.
Prepare reports, letters and other confidential materials
Track, validate expiring licensure, DEA certificates, OBNDD, malpractice coverage and any other required credentialing documents for all practitioners to ensure timely renewals
Auditing Medical Staff Credentialing files
Responding to health plan provider inquires
Maintains knowledge of current health plan and agency requirements for credentialing practitioners
Sets up and maintain practitioner Medical Staff Appointment/Re-Appointment files in online credentialing data base and practice management system
Ensures practice addresses are current with health plans, agencies and other entities
Audits health plan directories for current and accurate provider information
Maintains confidentiality of practitioner information
Edit or amend contracts and handle terms of contract breach
Prepare, review and evaluate contracts for compliance of legality and for profitability if applicable
Negotiate insurance contract terms and reimbursement rates on an annual bases
Assist Medical Director with monthly practitioner meetings; Journal Club monthly meeting; OSMA CME monthly training; OSMA practitioner yearly CME event
Assist Medical Director/Health Attorney with provider employment agreements
Assist Credentialing Specialist/Deputy Director with peer review and maintaining confidential folders
Track, audit, review and maintain credentialing hold claim status, add insurance effective dates within eClinicalWorks practice management system
Assist Medical Director/Deputy Medical Director as needed
Practitioner time clock, tracking vacation/sick leave
Maintaining bi-monthly provider meetings, agendas and monthly notes
Track, complete and maintain insurance contracts for CompleteCare Home Health
Track and maintain practitioner CME budget
Submit reimbursements for licensure, membership, subscriptions and book orders through Microix
Coordinate with the Travel Specialist/Medical Director regarding practitioner travel/training
Coordinate student schedules with HR, Medical Director, Deputy Medical Director and all other departments as directed
Coordinate the onboarding process with HR, EHR, and Administration for new hire practitioners
DIA system access form and Provider digital signature forms collected and completed to assist EHR
Maintain partial oversite for the Credentialing Specialist
Knowledge and understanding of the credentialing and privileging to maintain AAAHC Accreditation
Ability to organize and prioritize work and manage multiple priorities
Ability to work independently with minimal supervision
Performs other duties as assigned
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