CCI Health & Wellness Services
  • 20-Nov-2018 to 19-Feb-2019 (EST)
  • Silver Spring, MD, USA
  • Salary
  • Full Time

Position Summary

Responsible for the credentialing and privileging of all licensed and non-licensed providers; implementing necessary enrollment with federal, state commercial vendors, and performing other special projects as needed.

Key Functions & Responsibilities

  • Conduct verification of credentials for all licensed staff and contractual personnel including primary source verification (education), employment references, National Practitioner Data Bank Query (NPDB), Office of Attorney General Exclusion List (OIG), Licensing Verification, and American Medical Association Physician Profile and/or Board Certification.
  • Ensure provider credentialing applications are complete, accompanied with the appropriate requested documentation, and mailed via certified mail within 48 hours of receipt to the appropriate health care organization or hospital.
  • Enter credentialing data daily into the credentialing software and report weekly in writing on provider's status for employment and/or for status with participation into the Medicare and/or managed care plans.
  • Maintain daily update of provider profiles using the credentialing software by entering updated license and certification.
  • Coordinate and facilitate the new enrollment and maintenance of providers into negotiated contracts with commercial vendors.
  • Maintain confidentiality of all employee data and related human resources information.
  • Prepare and compile the necessary documentation and gather the appropriate signatures for provider initial appointment and reappointment of delineated privileges for the BOD's approval.
  • Compose letters and memoranda as needed.
  • Research and develop forms as needed upon request.
  • Work-up statistics and reports as needed.
  • Performs miscellaneous duties as required by management.
  • Complies with applicable legal requirements, standards, policies and procedures including, but not limited to, those within the Compliance Process, Code of Conduct, Federal False Claims Act, HIPAA and The Joint Commission.
  • Participates in compliance and other required training programs.
  • Prepares compliance reports, as required

Key Functions & Responsibilities

  • Ability to communicate effectively, both orally and in writing.
  • Program planning and implementation skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Informational research skills.
  • Ability to use independent judgment to manage and impart confidential information.
  • Database management skills including querying, reporting, and document generation.
  • Ability to make administrative/procedural decisions and judgments.

Minimum Qualifications

  • 2-4 year credentialing experience in a healthcare setting.
  • Proficiency in Microsoft Office; experience using spreadsheet and database software preferred.
  • Knowledge of federal and state laws and regulations, and Patient Centered Medical Home, Meaningful Use and Joint Commission standards
CCI Health & Wellness Services
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