Credentialing Specialist - Heartland Health Alliance (HHA) in Lincoln, Nebraska at Bryan Health

Credentialing Specialist - Heartland Health Alliance (HHA)

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:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

1. *Facilitates practitioner packets for appointment and reappointment.

1. *Coordinates procurement of Drug Enforcement Administration (DEA) information, licensure and malpractice insurance information.

1. *Provides practitioners with appropriate delineation of privilege forms.

1. *Completes primary source verification on practitioner applications.

1. *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.

1. *Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references).

1. *Builds and revises client privilege forms to ensure accuracy, compliance, and alignment with organizational standards.

1. *Prepares credentialing files for clients.

1. *Provides phone coverage for the Heartland Health Alliance office; relays messages in a timely fashion and provides information to callers as appropriate.

1. *Identifies and notates the practitioner file with any potential red flag findings in the verification process.

1. *Sorts and routes incoming departmental mail; delivers out-going department mail.

1. *Maintains departmental files including processing file revisions.

1. *Performs copying, faxing, printing and distribution of information.

1. *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).

1. *Maintains information on sanctions and insurance liability claims.

1. *Provides quality assurance audit for each practitioner file prior to file release to the client.

1. *Utilizes relevant software to produce communication; sets up databases and tracks regulation compliance

1. Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs

1. Prepares and maintains monthly billing documentation to ensure clients are properly billed for all appointments, reappointments and other miscellaneous offerings.

1. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

1. Participates in meetings, committees and department projects as assigned.

1. Performs other related projects and duties as assigned.

Essential Job functions are marked with an asterisk “*”.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of credentialing procedures and processes.

1. Knowledge of computer hardware equipment and software applications relevant to work functions.

1. Ability to meet firm deadlines.

1. Ability to perform basic mathematical computations.

1. Ability to practice proper body mechanics to ensure personal and customer/patient safety.

1. Ability to communicate effectively both verbally and in writing.

1. Ability to perform crucial conversations with desired outcomes.

1. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

1. Ability to problem solve and engage independent critical thinking skills.

1. Ability to maintain confidentiality relevant to sensitive information.

1. Ability to prioritize work demands and work with minimal supervision.

1. 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.