Credentialing Analyst

Credentialing Analyst at NEW OP Template (PR & TLM

MME / HR

Enterprise) - Pay Calc 2.0 Credentialing Analyst at NEW OP Template (PR & TLM

MME / HR

Enterprise) - Pay Calc 2.0 in Redding, California Posted in 7 days ago.

Type:

Full-Time Job Description:

Base Pay:

$23.00 - $ 33.80 / hour

JOB SUMMARY

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who provide patient care at Shasta Community Health Center (SCHC). Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. Responsible for ensuring providers are credentialed, appointed, and are privileged with SCHC, health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

JOB DUTIES AND RESPONSIBILITIES

• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications of SCHC providers to address SCHC obligations with outside agencies; monitors applications and follows-up as needed.
• Tracks license, DEA and professional licensing expirations for appointed SCHC providers; tracks professional liability for specially contracted providers if not covered under SCHC's FTCA coverage and gap coverage
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks license and certification expirations for all clinical staff to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Processes applications for appointment and reappointment of privileges to SCHC.
• Maintains SCHC appointment files, and information in credentialing database.
• Audits health plan directories for current and accurate provider information.
• Assists in processing care application for providers
• Identify problems with current systems, policies and procedures to ensure compliance with BPHR and HRSA Compliance Manual, other related laws and regulations, and best practices.

o Anticipate issues with current system to avoid any non- compliance. o Assess problems and report to management team. o Propose potential solutions and changes. o Establish changes to systems. o Establish training/ communications for changes to keep management team and impacted staff.

• Create and maintain required documentation for OPPE.
• Support and enforce compliance with credentialing and privileging requirements by SCHC staff in coordination with the Human Resources, Medical Staff Office Manager, and other Senior Management officers.
• Produce and analyze monthly exclusions checks and related reports for SCHC employees, contracted providers and board members.
• Develops materials for credentialing and privileging reviews.
• Coordinates and facilitates credentialing committee reviews and actions.
• Coordinates with Senior Clinical Recruiter and Medical Staff Office to assess and address credentialing and privileging needs of new staff.
• Understands and adheres to the Ethics, Compliance and Code of Conduct policy. Additional Responsibilities
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verifications.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge and understanding of the credentialing process.
• Strong communication skills.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including letters, memos and emails.
• Ability to read, write, understand and spell English and medical terminology correctly.
• Excellent people skills and customer service orientation.
• Excellent attention to detail.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.

EDUCATION & EXPERIENCE

• Associate degree or equivalent training and/or experience