Resources For Human Development, Inc.
Requisition Number: FAMPR-CREDS-H-08-2018-01
Job Title: Credentialing Specialist
City: Philadelphia
State: PA

Minimum Degree Required: B - 2 Year Degree
Minimum Years of Experience: 2
Salary Range: $37,000-$43,000

Credentialing Specialist

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Description/Job Summary

 

 

Family Practice & Counseling Network is seeking a Credentialing Specialist that is responsible for the timely and accurate payor credentialing for all FPCN providers. The Specialist will processes applications, verify information, research application details, and assure processes are in accordance with NCQA standards and applicable laws. The Specialist will provide consistent, accurate, and timely credentialing support, enhancing the Network’s ability to provide quality healthcare services. In addition, the Credentialing Specialist will uphold  the  mission  and  beliefs  of  the  organization  by  working  with  the HR and Billing teams to ensure that all requirements are met for credentialing and enrollment for staff.

Essential Duties and Functions

Administrative Duties

  1. Perform accurate, timely and documented verification of the information provided by the provider.
  2. Assist Human Resources (HR) with the onboarding process of licensed and/or certified new hires. In coordination with HR, schedule and conduct on-site provider new hire, credentialing meetings.
  3. Obtain required original signatures for all applicable documents and applications.
  4. Follow-up on any missing documents to ensure these are received as quickly as possible.
  5. Utilizes credentialing technology solutions (IntelliApp) to optimize provider credentialing, payor enrollment, application completion and document tracking processes.
  6. Scan and log all obtained documents and document all credentialing/enrollment actions in IntelliApp timely and accurately.
  7. Working with outside agencies, such as Drexel and U of P, Obtains and maintains the Hospital Attestations, Prescriptive authorities, DEA certificates, Collaborative Agreements, CAQH files, as well as CLIA certificates.
  8. Process payor enrollment and re-enrollment applications (electronic whenever possible) for all billable providers in all 5 disciplines, timely and accurately with the goal of not getting any applications returned for incomplete information.
  9. Prompt response and follow-up (at least weekly) on enrollment issues is essential.
  10. Ensure that benefit reassignment is accurately given to RHD/FPCN when completing applications.
  11. Assists in maintaining compliance with documentation standards for verification of employee credentialing requirements, including but not limited to licenses, certifications, registrations, permits, educational degrees, association memberships.
  12. Tracks and maintains copies of current credentialing documents and performs primary verifications and ensures: State licenses, certificates, malpractice coverage, and other required credentialing documents in confidential provider files.
  13. Update CAQH database with quarterly attestations, updating credentialing documents as needed/required.
  14. Using the PECOS system, assigns delegation status for all Medicare participating providers to credentialing staff.
  15. Tracks and maintains Medicare exclusion checks for entire staff.
  16. Provides guidance to providers and hiring managers in completing privileging credentialing requirements to meet compliance standards.
  17. Maintains knowledge of standards of the Health Resources and Services Administration, Federal Tort Claims Act (FTCA), CMS, NCQA, federal and state regulations, and other organizations as applicable.
  18. Provides guidance to FPCN staff about credentialing/enrollment compliance and processes.
  19. Identifies and communicates payor enrollment, re-enrollment and termination needs in a timely fashion.
  20. Maintains active, current payor rosters with all participating insurance plans for all 5 disciplines.
  21. Obtains and maintains access to all payor, licensing, credentialing portals as needed for timely electronic data verification and document access.
  22. Has good working knowledge of the PECOS, Promise, NCQA, etc… websites and actively seeks to stay current on credentialing and enrollment processes and procedures.
  23. Assists the credentialing Manager with completing/coordinating audit activities.
  24. Maintains confidentiality of provider information.
  25. Other responsibilities as assigned.
                                                                              
Communication & Interpersonal Relations 
  1. Maintains ongoing communication with providers regarding: Enrollment status and need for any additional related information.
  2. Actively participates in monthly Credentialing Committee meetings to presentverification findings.
  3. Open communication with operation managers regarding the credentialing status and any on-going issues
  4. Regular communication with Credentialing Manager and other Senior staff of any updates of credentialing issues.
  5. Ability to work professionally and collaboratively.
  6. Independent and reliable.

Qualifications

  • Certified Professional Credentialing Specialist (CPCS Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMCS) by the National Association of Medical Staff Services (NAMSS) preferred
  • Professional and effective oral and written communication skills
  • Organizational skills; ability to multi-task and manage priorities; meets critical deadlines.
  • Proficient in Microsoft Excel, Outlook and Word and proprietary database applications.
  • Knowledge of provider credentialing criteria and processes in accordance with NCQA standards, NPDB guidelines and general licensing regulations.
  • Familiarity with community health centers with both medical/dental practices.
  • Experience with Intellisoft and/or CRM database preferred.
  • Knowledge of Electronic Health Records a plus.

Family Practice and Counseling Network, a program of Resources for Human Development, is a network of community health centers providing comprehensive primary care, dental and behavioral health services. The Network consists of four health centers in Philadelphia – Abbottsford-Falls Family Practice & Counseling in the Northwest, the Stephen and Sandra Sheller 11th Street Family Health Services of Drexel University in the North, the Health Annex in the Southwest, and Annex West Health Center in West Philly housed in Action Wellness building (formerly Action AIDS); a convenient care clinic in Philadelphia – Fast Family Care. Today the Network serves more than 20,000 patients annually and is an NCQA certified Patient-Centered Medical Home.

The Network’s mission is to provide person-centered, integrated and comprehensive health services to individuals and families across their lifespan. The Network promotes resiliency and well-being among patients, staff and surrounding communities. Network services are targeted to the surrounding communities and the advisory committee that guides services primarily consists of people from the communities served.

Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.

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Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.