Credentialing Representative

Why work for Nebraska Methodist Health System?

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary

Location: Methodist Corporate Office

Address: 825 S 169th St. - Omaha, NE

Work Schedule: Monday through Friday, 8am - 5pm

Responsible for coordinating with medical staff coordinators at numerous facilities around the region for credentialing and privileging providers as well as submitting provider information to insurance payers, state Medicaids and Medicare. Ensuring that state medical licenses, DEA's, controlled substance certificates, malpractice and board certification are current for all providers.

Responsibilities

Essential Functions

Coordinates with staff of Nebraska Methodist Hospital (NMH), Jennie Edmundson Methodist Hospital (JEMH) and Methodist Physicians Clinics (MPC) for processing of credentialing paperwork for employed physicians and mid-levels to include but not limited to completing applications for Nebraska Credentials Verification Organization (NCVO), MHP/HPWI Physician Hospital Organization (PHO), Medical Malpractice Insurance, Medicaid, Medicare, Wellmark, Tricare, DEA Federal, Medical License, Advanced Practice Registered Nurse (APRN) practice agreement, PA Supervising License.

• Meets with provider for completion of applications and to obtain copies of necessary documents in a timely manner.
• Follows guidelines in submitting paperwork for appropriate offices in a timely manner.
• Follows procedures to insure applications are in compliance with Credentialing Process.
  
  

Communicates effective start dates and other provider information to Office Managers, Regional Administrators and Business Office.

• Follows up and communicates with various entities until effective date, licensure or certificate obtained.
• Has established contacts with various plans, Medicare representatives and entities.
• Maintains Managed Care Data Base indicating various managed Care and Government plan effective date.
  
  

Follows policies in accordance with Medicare and Medicaid guidelines and insures that the clinic providers initial application/reappointment applications are submitted as compliant with Medicare policies.

• Demonstrates knowledge of Medicare guidelines.
• Follows up with appropriate entity until an effective date and provider number has been established.
  
  

Works within a physician database to view provider data, including but not limited to license and DEA expirations, board certification and office demographics.

• Utilizes database and internet to view provider data.
• Communicates with provider regarding certificate and licensure expirations. Assists provider with renewals of certificate and licensures.
• Updates database and provider files with current and renewed provider data.
  
  

Processes National Practitioner Identification (NPI) number and Taxonomy code for providers.

• Follows policies and guidelines in obtaining NPI # and Taxonomy code for provider.
• Compiles NPI information in physician database.
• Keep up to date on current NPI policies and procedures.
  
  

Identifies and researches credentialing issues, answers queries posed by Providers, Health System personnel, Physician Hospital Organization (PHO), Hospitals and Managed Care entities.

• Successfully follows up on issues and queries by all personnel.
• Returns phone calls in a timely manner.
• Communicates effectively with customers and staff.
  
  

Provides appropriate care specific to the age of the patient to ensure understanding and comfort level of treatment as outlined in the “Age Specific Criteria”.

Schedule

Work Schedule: Monday through Friday, 8am - 5pm

Job Description

Job Requirements

Education

• Associate degree in Business Administration or Health Care Management required or 3-5 years of experience in the healthcare field, preferred.
• Additional educational background related to credentialing insurance products and/or insurance industry, preferred
  
  

Experience

• 3-5 years credentialing experience.
  
  

License/Certifications

• N/A
  
  

Skills/Knowledge/Abilities

• Ability to understand basic credentialing procedures and communicate effectively with internal and external parties to the organization
• Medical terminology knowledge preferred.
• Strong computer skills and attention to detail required. Ability to accurately enter provider information into database.
• Ability to work in a fast-paced environment with frequent interruptions and involving team work and good communication/customer service skills.
• Ability to multi-task frequently, adapt to frequent change and be self-motivated.
• Ability to maintain confidentiality is required.
  
  

Physical Requirements

Weight Demands

• Sedentary Work - Exerting up to 10 pounds of force. Sitting most of the time. Walking and Standing are required only occasionally.
  
  

Physical Activity

• Not neccessary for the position (0%):
• Climbing
• Crawling
• Crouching
• Occasionally Performed (1%-33%):
• Balancing
• Carrying
• Kneeling
• Lifting
• Pulling/Pushing
• Reaching
• Standing
• Stooping/bending
• Twisting
• Walking
• Constantly Performed (67%-100%):
• Distinguish colors
• Fingering/Touching
• Grasping
• Hearing
• Keyboarding/typing
• Repetitive Motions
• Seeing/Visual
• Sitting
• Speaking/talking
  

Job Hazards

• Not Related:
• Chemical agents (Toxic, Corrosive, Flammable, Latex)
• Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
• Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
• Equipment/Machinery/Tools
• Explosives (pressurized gas)
• Electrical Shock/Static
• Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
• Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Mechanical moving parts/vibrations
  

About Methodist

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.