Credentialing Specialist

PURPOSE AND SCOPE:

Knowledgeable, experienced specialist responsible for initial verification for all existing and new providers to allow the practitionerto admit and treat patients atFMCNA locations.

Collaborates with external credentialingagent to ensure credentialing processis completed.

Ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards and FMCNA policy and procedure.

Performs audits of internal FMCNA Provider Database and FMCNA provider information compiled by the external credential verification agent to ensure that credential verification is completed in a timely manner according to all regulatory and company requirements.

Supports FMCNA's mission, vision, core values and customer service philosophy.

Adheres to the Compliance Program, including following all regulatory and division/company policy requirements.

 

PRINCIPAL DUTIES AND RESPONSIBILITIES:


* Under limited supervision, applies considerable credentialing knowledge and skills to perform a wide range of moderately difficult tasks and assignments requiring judgment in resolving issues and/or in making recommendations.

Normally receives no instruction on routine daily work, and general instructions on newly introduced assignments


* Contacts are frequently with individuals representing other departments, and/or representing outside organizations.  Contacts involve obtaining or providing information or data on matters of moderate importance to the function of the department or which may be of a sensitive nature.


* Perform provider credentialing verification tasks to facilitate compliance with Medical Staff by-laws regardingthe verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment.

Responsiblefor tasks related to the three year cyclical verification process of all active practitioners.


* Apply knowledge regarding national accreditation standards, internal medical staff bylaws and other related policies and regulations to perform functionspertaining to the provider credentialing process for the assigned division.

This includes but is not limited to:
+ Obtaining practitionerlicense information from publicly available state/government agency websites, the National Provider Databank, and other 3rdparty certification groups such as the American Board of Internal Medicine.
+ Completing and processing all initial credential applications for new providers/practitionersand credential verification applications for existing providers in a timely and accurate manner.
+ Conducting follow-up as needed, acting as the primary liaison for FMCNA locations, practitioners, and the FMCNA third-party credentialing agent to ensure that all credentialing is completed within the required timelines and that each provider meets federal and state regulations as well as FMCNA internalrequirements.
+ Maintaining a...