Medical Credentialing Specialist

Job Description: 

Full job description 

Foothills Neurology is an expansive physician network of Neurologist, Hospitalists, and APPs that are passionate about helping the needs of the communities and the Hospital Partnerships we serve. By working with Foothills Neurology, our patients receive full-time dedicated providers on site, filling a critical void in care coverage and allowing for better patient outcomes. 

Summary 

Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing. Facilitates all aspects of Foothills Neurology Group credentialing, including initial appointment, reappointment, expirable process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the contracted hospital client’s Medical Staff Bylaws, policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. 

Credentialing: 

• Leads, coordinates, drafts and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 

• Responsible for tracking and ensuring timely completion of all reappointments for each physician at each facility. 

• Scrutinize provider applications and CVs for completion, consistency, and accuracy. Quickly identify any discrepancies, gaps of employment and other challenges that could negatively impact our ability to credential a provider. 

• Maintain strict Confidentiality and Conducts thorough background investigation, research, and primary source verification of all components of the application file by mailing, faxing, emailing, or calling hospitals, licensing boards, medical schools, etc.in order to obtain verifications, references, and other pertinent data from appropriate sources in a timely manner. 

• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 

• Prepares applications for hospital privileges and medical malpractice insurance for completion and ensures timely and accurate submission to hospitals for each physician and allied health professional as it relates to each contracted hospital client ensuring file completion within time periods specified. 

• Process, obtain and maintain malpractice insurance for each facility including verifications and claims history as required 

• Prepare/process applications for State Controlled Substances, DEA Applications and changes and enrollments with Prescription monitoring programs as needed. 

• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions. 

• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. 

• Assists with managed care delegated credentialing audits; conducts internal file audits. 

• Works closely with the physicians billing company and provides documentation and assistance as needed. 

• Integrate and utilizes the credentialing database, optimizing efficiency, and performs query, report, and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act. 

• Conducts compliance and sanctions monitoring. Notifying the Executive team of negative findings immediately. 

• Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies, and procedures of contracted hospitals. 

• Monitor and report on the credentialing progress of each physician. 

• Work closely with contracted physicians, the hospital’s Medical Staff Services department, and any 3rd party groups in order to follow up on outstanding items needed to complete files in a timely manner to ensure that we meet applicable committee meeting dates and targeted start dates. 

• Respond timely to all requests from Physicians, Clients or their Medical Staff Services departments. 

• Performs miscellaneous job-related duties as assigned. 

Minimum Job Requirements: 

• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis. 

• High school diploma or GED; at least 4 years of experience with 2 years directly related to hospital medical staff or physician credentialing. 

• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred. 

Knowledge, Skills and Abilities Required: 

Possess the knowledge, as well as the following skills and abilities or be able to perform the essential functions of the job, with or without reasonable accommodation, using some other combination of knowledge, skills and abilities. 

• Excellent interpersonal, written, verbal and presentation skills with the ability to communicate and discuss information in a professional and sensitive manner. 

• Strong organizational, critical thinking and problem-solving skills. 

About Us: 

Foothills Neurology is a busy neurology practice with locations throughout the valley.  We are looking for a full time Infusion Nurse to grow with our team. This is a full-time position with benefits. Workdays are Monday - Friday and hours are generally 8am - 5pm. 

As we work together to put the needs of the patient first, we are also dedicated to our employees, providing benefit plans to take care of you and your family, now and in the future. You can thrive in an environment that is fun and provides the resources you need to succeed. 

Benefits: 

• 401(k) matching 

• Dental insurance 

• Health insurance 

• Vision insurance 

• Paid time off 

• Seven paid holidays 

• Continuing Education