Description

Tidewater Physicians Multispecialty Group (TPMG) has an exciting opportunity for an experienced Credentialing Specialist II to join our Credentialing Department team. If you have a fantastic understanding of the latest medical policies, previous experience in this field, a strong work ethic, and the ability to properly record and supplement data, this position will be for you! Please consider applying. We would love to have you on our team!

Core Business Hours are 8:30am to 5:00pm Monday - Friday.

Position Summary

As a Credentialing Specialist II, you must research, compile and maintain reports that detail medical staff accreditation, organizational membership and adherence to facility policies. This includes fact-checking with various certification boards and agencies. All information must be entered into a secure online database and updated regularly. This database should include each medical provider's DEA certificates, state licenses and malpractice insurance coverage. You will also regularly complete and submit staff credentialing or re-credentialing applications to the appropriate agencies and track when certifications are due to expire. In some cases, you might even be tasked with overseeing the auditing of a facility or individual practitioner. Therefore, staying current on state and federal regulatory requirements is vital to the effective execution of your duties; may take lead in group.

Major Duties and Responsibilities:

• Compiles and maintains current and accurate data for all providers. Database management of One App Pro software and CAQH, NPPES and VBOM.
• Compiles and maintains current and accurate data for all providers. Database management of One App Pro software and CAQH, NPPES and NPDB, OIG, SAM and VBOM complaint management for all specialties and provider enrollment.
• Working knowledge of provider credentialing and Re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains corporate provider contract files with varies payers.
• Working knowledge of hospital credentialing to include initial and reappointments. Coordinates and provides administrative support with initial credentialing and privilege delineation activities in accordance with the medical staff policies, bylaws, and rules and regulations so as to ensure that only qualified practitioners provide care at this hospital.
• Initiates information collection, verification, and documentation processes for completed application per established hospital medical staff office policies and procedures.
• When applicable and in accordance with medical staff bylaws, policies, and procedures, notifies all appropriate parties of any action taken.
• Maintains knowledge of current malpractice requirements for credentialing providers.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Processes applications for appointment and reappointment of privileges.
• Audits health plan directories for current and accurate provider information. Update payer with current provider information.
• Handle correspondence with providers including updates, mailings of applications, completed executed agreements
• Tracks & submits licensure renewal requests, and ensures that all provider’s licenses are current
• Prepares accurate and timely reports for clients and internal staff
• Process all applications for credentialing, re-credentialing, initial appointments, and re-appointments for medical license and DEA certificates.
• Responding to medical staff office requests in a timely manner.
• Maintains CAQH online applications for providers as well as NPPES database.
• Maintains and apply for new NPI information
• Notifies Central Billing Office Manager with instructions for new providers’ billing
• Maintains fee schedules and handle all requests for reimbursement
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verifications.
• Other duties as assigned.

Qualifications

Knowledge, Skills and Abilities

• Excellent attention to detail is necessary.
• Excellent interpersonal and verbal/written communication skills including letters, memos and emails.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources. Knowledge of database management.
• Skill in providing excellent customer service.
• Ability to modify own working style, approach, or methodology to fit new/changing circumstances.
• Ability to present information in an organized manner.
• Ability to research and analyze data.
• Ability to learn quickly and work independently with minimal supervision.
• Ability to be consistent and follow up on all processes.

Education / Training / Requirements

• High school diploma or equivalent required.
• Bachelor’s Degree preferred.
• Minimum of 3 to 5 years of multispecialty provider enrollment/medical staff credentialing required.

Physical Demands

• Ability to stand and walk for limited periods of time.
• Ability to sit for extended periods of time.
• Ability to climb stairs occasionally.
• Ability to enter data into a computer via a keyboard.
• Ability to occasionally reach, bend, stoop and lift up to 20 lbs. *
• Ability to grasp and hold up to 20 lbs.*
• Ability to occasionally squat and lean over.
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Basic vision, corrected.
• Ability to see and understand data on a computer screen.

Working Conditions (environment and safety):

• Work performed in office environment.
• Involves frequent contact colleagues, clinical providers, and hospital medical staff service dept.
• Work may be stressful at times.
• Interaction with others is frequent and often disruptive. is frequent and often disruptive.

Success Factors

• Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail

All statements are essential functions of the position unless identified as non-essential by an asterisk (*).