Advance Health

Credentialing Specialist

US-VA-Chantilly
3 months ago(11/7/2017 7:26 AM)
Job ID
2017-2137
Classification
Non-Exempt
Type
Regular Full-Time
# of Openings
1

Overview

Advance Health is a privately owned company focusing on health assessments and care coordination to seniors in their homes. Our goal is to improve the health of seniors by offering quality home health services. The data we collect helps enhance the effectiveness of the care management programs. As navigating the health care system becomes increasingly complex, it is important to help our seniors receive the services needed to maintain healthy lifestyles and hire quality Nurse Practitioners to do the job.

 

The Credentialing Specialist is responsible for, coordinating, monitoring, processing of applicants, and maintaining the credentialing and re-credentialing process. Facilitates the Advance Health credentialing process, including initial credentialing, re-credentialing, ongoing monitoring and expirations process.  Supports the 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. Works under the supervision of the Credentialing Manager.

 

Responsibilities

  • Utilizes CAQH Proview, maintaining the roster for reconciliation of billing reports and processing of extract files; coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility; manages SanctionsTrack automated, continuous monitoring of licensing boards, OPM and OIG ensuring provider disciplinary actions are identified and addressed.
  • Utilizes the Cactus 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 background investigation, research and primary source verification of defined components of the application file.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and facilitates appropriate follow up.
  • Prepares credentials file for completion and presentation to Advance Health Credentialing Committee, making certain file completion within time periods specified.
  • Answers inquiries regarding providers' credential status and works with colleagues to ensure the accuracy of all files by tracking the expiration of licenses and certifications.
  • Responds to inquiries from internal and external customers on day-to-day credentialing issues as they arise.
  • Monitors the initial credentialing, re-credentialing, ongoing monitoring and expirations process for all nurse practitioner staff ensuring compliance with regulatory bodies (NCQA, CMS, federal and state), as well as Advance Health Credentialing policies and procedures, and delegated contracts.
  • Assists with delegated credentialing audits; conducts internal file audits.
  • Performs miscellaneous job-related duties as assigned.

Qualifications

  • High school diploma or GED minimum educational requirement; associate/bachelor degree preferred.
  • At least 2 years’ previous experience in the health care industry; directly related to hospital medical staff or managed care credentialing preferred.
  • NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred or actively pursuing certification to be completed within two years of employment.
  • Excellent organizational and time-management skills.
  • Excellent verbal and written communication skills.
  • Program planning and implementation skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of practitioner credentialing procedures and standards.
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Working knowledge of clinical 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.

 

 

*Advance Health is an Equal Opportunity Employer*

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