Job Summary

WELLBE INTRODUCTION

The WellBe care model is a Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care. WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

Job Description

OBJECTIVES

The Credentialing Analyst is a critical member of the Credentialing team, assisting Credentialing Specialists in the onboarding credentialing, and enrollment of all WellBe Providers. The successful candidate should be detail oriented with excellent communication skills.

GENERAL SUMMARY

• Update roster provided to billing vendor (EMP Claims) for billing purposes (using read-only access to credentialing software).
• Export WellBe information into individual practitioner Council for Affordable Quality Healthcare, Inc. (CAQH) account.
• Copy and paste practitioner information into medical malpractice spreadsheets. Send malpractice spreadsheets every Friday (weekly) to the malpractice insurance carrier. Receive certificates of insurance the following week and track receipt.
• Manage the released files to place them on the Credentialing Committee agenda spreadsheet.
• Update template and email individual practitioner approval letters as result of Credentialing Committee approval.
• Compile semi-annual Aetna audit list. (List of provider additions/terminations during last 6 months).
• Manage expirables spreadsheet and email notifications, and attach reimbursement policy & form.
• Review Credentialing Verification Organization (CVO) files to see if a connection request has been made.
• Request monthly rosters from the payors to ensure practitioners are getting enrolled (compare with information sent to the payors).
• Review monthly rosters to ensure terminations were made on plan side.
• Assist Credentialing Specialists with Collaborative agreements and preboarding roster updates.
• Updating Aetna rosters that require continuous update.
• Coordinate with Human Resources to ensure contracted physician background checks are complete prior to start date.
• Prepare and participate in health plan audits as needed.
• Observe WellBe Senior Medical Group’s policies and procedures, client contract requirements, state guidelines, and National Committee for Quality Assurance (NCQA) standards.
• Update the ongoing monitoring reports received from Credentialing Verification Organization (CVO) and review potential matches with direct supervisor and Credentialing Chair for all states.
• Coordinating and validating chart reviews between the supervising physician and nurse practitioner
• Other administrative duties as determined.

SKILLS & COMPETENCIES

To perform the job successfully, an individual should demonstrate the following competencies:

• Excellent detail orientation and organizational skills
• Ability to maintain confidentiality
• Strong written and verbal communication skills
• Effective interpersonal skills

Job Requirements

QUALIFICATIONS

Educational Requirements

• High school graduate or equivalent
• Windows-based computer skills

Required Skills and Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibility: No Supervisory responsibilities.

Travel Requirements: None

Work Conditions: Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs.

• Ability to stand for extended periods
• Ability to drive to patient locations (ie. home, hospital, skilled nursing facility (SNF), etc)
• Fine motor skills
• Visual acuity

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.