Description

Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is to spark equity through patient-led healthcare that welcomes and strengthens our communities by integrating body, mind, and heart.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.

Qualifications

JOB SUMMARY

The Credentialing Specialist is responsible for all facets of the credentialing process for Professional and back up for Payer Credentialing. This position works closely with the Compliance, Billing, and Clinicians to ensure that all required documentation is obtained as requested. This position is also required to keep an accurate account of all licensees, certification etc., to make sure they are current.

SPECIFIC JOB DUTIES

CREDENTIALING - Professional

1. Participate in Interview of potential applicants to explain credentialing process

2. Credential Newly Hired Providers (see provider worksheet)

3. Advise Lancaster General of new Physicians to start Hospital Privileges process

4. Add Providers to Athena (see Athena notes) and encounter oversight

5. Add clinical staff to FTCA report

6. Prepare Monthly Board Report of Credentialed Providers

7. Re-credential (ongoing) 2 years from date of last credential for 100 clinical staff

8. Maintain Paycom Credentialing Form

HUMAN RESOURCES Professional

9. Complete employment verification requests.

10. Complete miscellaneous employee information requests such as pay history, position history, proof of training, respond to subpoena’s, etc.

11. Maintain employee paper files and records.

12. Assist with review of new policies and procedures.

13. Provide support to employees in various HR -related topics such as policies and procedures, assistance with resolving issues as they arrive.

Miscellaneous

14. Provide back up and/or assist Billing staff with Payer credentialing issues.

15. Communicate with Clinical staff ensuring all licensure and other professional documents are current

16. Maintenance of Clinical Staff Files paper and electronic

17. Maintenance of various provider listings

18. Liaison between UCC Providers and Lancaster General Medical Staff Office

POSITION REQUIREMENTS

Bachelor’s Degree or (2) years’ experience (certificates or schooling)

Credentialing experience and working with third party payers

Understanding of employment rules and regulations

English proficiency required

ESSENTIAL FUNCTIONS

In order to fulfill the requirements of this position, duties 1-30 are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.