Credentialing Specialist - Heartland Health Alliance (HHA)

Job description

GENERAL SUMMARY:
Ensures that practitioner credentialing files are completed and returned to Heartland Health Alliance (HHA) clients in a timely and accurate manner.
PRINCIPAL JOB FUNCTIONS:
• *Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• *Facilitates practitioner packets for appointment and reappointment.
• *Coordinates procurement of Drug Enforcement Administration (DEA) information, licensure and malpractice insurance information.
• *Provides practitioners with appropriate delineation of privilege forms.
• *Completes primary source verification on practitioner applications.
• *Ensures that all practitioner credentialing files are completed and submitted back to the client within 30 business days of receipt of the completed application and supporting documents.
• *Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references).
• *Builds and revises client privilege forms to ensure accuracy, compliance, and alignment with organizational standards.
• *Prepares credentialing files for clients.
• *Provides phone coverage for the Heartland Health Alliance office; relays messages in a timely fashion and provides information to callers as appropriate.
• *Identifies and notates the practitioner file with any potential red flag findings in the verification process.
• *Sorts and routes incoming departmental mail; delivers out-going department mail.
• *Maintains departmental files including processing file revisions.
• *Performs copying, faxing, printing and distribution of information.
• *Proactively requests upcoming expirable items and communicate with the client to ensure that the file is kept current (i.e. State License, DEA License and Malpractice Insurances).
• *Maintains information on sanctions and insurance liability claims.
• *Provides quality assurance audit for each practitioner file prior to file release to the client.
• *Utilizes relevant software to produce communication; sets up databases and tracks regulation compliance
• Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs
• Prepares and maintains monthly billing documentation to ensure clients are properly billed for all appointments, reappointments and other miscellaneous offerings.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.
• Performs other related projects and duties as assigned.

Essential Job functions are marked with an asterisk “*”.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
• Knowledge of credentialing procedures and processes.
• Knowledge of computer hardware equipment and software applications relevant to work functions.
• Ability to meet firm deadlines.
• Ability to perform basic mathematical computations.
• Ability to practice proper body mechanics to ensure personal and customer/patient safety.
• Ability to communicate effectively both verbally and in writing.
• Ability to perform crucial conversations with desired outcomes.
• Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.
• Ability to problem solve and engage independent critical thinking skills.
• Ability to maintain confidentiality relevant to sensitive information.
• Ability to prioritize work demands and work with minimal supervision.
• Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:
High school diploma or equivalent required. Prior medical office experience required.
OTHER CREDENTIALS / CERTIFICATIONS:
None
PHYSICAL REQUIREMENTS:
(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)
(DOT) – Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.