What are the responsibilities and job description for the CREDENTIALING ASSOCIATE position at Care Resource?
The Credentialing Associate is responsible for all aspects of the privileging and credentialing process for all licensed clinician/providers of the center (i.e. physicians, physician assistants, ARNPs, dentist, dental hygienist, clinical counselors, etc.). In addition, this position is responsible for all communication leading toward insurance panel accreditation for staff and center. They will also provide support in managing all insurance for the health center.
Essential Job Responsibilities
Administrative/Accreditation Duties:
- Research and processes new health plan applications and enrollment for Center and its providers.
- Assist in maintaining and monitoring the credentialing and re credentialing process.
- Utilize the ECHO/OneApp Pro software database, perform queries, reports and spreadsheets.
- Responsible for accuracy and integrity of the credential database.
- Provide consistent, accurate, and timely credentialing support to management for the center’s accreditation process.
- Ensure interpretation and compliance with the appropriate accreditation regulatory agencies on any certifications the organization may decide to pursue.
- Communicate with all appropriate internal parties of any existing/available incentive initiatives through Medicaid, Medicare, and Commercial Health plans.
- Assist in the completion of Medicare/PECOS and Medicaid Provider Enrollment applications, monitor and follow-up as needed.
- Assist in the verification of all information/documentation provided by new applicants, as well as current providers.
- Provide support with the onboarding process of all new providers.
- Communicate effectively to any inquiries from all departments throughout the agency regarding provider participation, credential status, and by responding in a timely manner.
- Assist with the screening and distribution of reports received from contracted health plans.
- Assist in the coordination of all additions, terminations, and changes to current agreement with health plans, as appropriate.
- Prepare and maintain reports on all accreditation and credentialing activities as required.
- Support managements effort to maintain compliance in the documentation standards for verification of all employees credentialing requirements.
- Support the coordination of maintaining up to date record keeping for all providers in the various databases, i.e., ECHO and CAQH.
- Provide support to management ensuring the credentialing process of the Health Center is fully compliant with HIPAA and Joint Commission guidelines.
- Comply with the timely completion of all trainings requirements set by the Health Center Administration Department.
Culture of Service: 3 C’s
Compassion
- Greet internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.
- Listen to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring an understanding of the request and providing appropriate options or resolutions.
Competency
- Provide services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered
Commitment
- Take initiative and anticipate internal or external customer needs by engaging them in the process and following up as needed.
- Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure prompt and effective response are provided
Safety
- Ensure proper handwashing according to the Centers for Disease Control and Prevention guidelines.
- Understand and appropriately act upon the assigned role in Emergency Code System.
- Understand and perform the assigned roles in the organization’s Continuity of Operations Plan (COOP).
Contact Responsibility
The responsibility for internal and external contacts is frequent and important.
Physical Requirements
This work requires the following physical activities: constant writing, sitting, standing, talking in person, talking on the phone, hearing/ visual acuity. Frequent walking and occasional bending, stretching and reaching may be required. Work is performed predominantly in an office setting, with occasional instances of short-distance travel.
Other
Participates in health center developmental activities as requested.
Other duties as assigned.
