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Location:
Work from home (Pennsylvania) Shift:
Days (United States of America) Scheduled Weekly Hours:
40 Worker Type:
Regular Exemption Status:
No Job Summary:
Plans, coordinates, and oversees procedures and processes of the Provider Credentialing Program in compliance with regulatory requirements. Ensures compliance with all credentialing and privileging requirements of applicable regulatory agencies. Conducts background investigations on physicians and other providers applying for affiliation including licensure, education and post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence at time of appointment, reappointment, and cross credentialing. Job Duties:
Preferred experience in Echo or Credential Stream
Reviews and analyzes physician applications and credentialing documents including certificates of education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance and malpractice history.
Assesses completeness of information and providers' qualifications relative to established standards.
Reviews and analyzes primary source verification for licensure, certification or registration required to practice a profession.
Requests, maintains, and ensures competency data is present at appointment and re-appointment.
Maintains tracking of all new providers drug screening, background checks, child abuse clearance, finger printing, code of conduct, disruptive practitioner policies, current clinical competency data and Health Service information for new providers.
Maintains a working knowledge of applicable regulatory agencies.
Immediately reports to manager any collected information which may be averse to an applicant.
Identifies and flags adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for credentialing review.
Maintains an understanding of the third-party payor requirements.
Prepares and screens, mails letter, tracks and responds daily.
Employs public relations skills in a wide variety of phone contacts with external sources for purposes of soliciting information essential to credentials investigations, including licensing agencies; university and hospital training program administrators; certification boards; liability insurance carriers; hospital officials and credentials staff; and physicians and their office staffs.
Organizes and maintains physician files and information following confidentiality guidelines, performs varied clerical support functions.
Internally audits and maintains physician files in accordance with established principles of legal documentation and confidentiality.
Prepare all files monthly for Credentials Committee review and follow-up on Credentials Committee Decisions.
Establish and maintain excellent relationship and good communication channels with physicians, office staff, and practice administrators.
Assist with Special projects (i.e., physician education, JCAHO and Department of Health Preparation, clinical competency data, life supports) Maintain a thorough understanding of the standards of JCAHO, Department of Health, Bylaws, Rules and Regulation of the Medical Staff, and other regulatory agencies as appropriate.
Maintains provider database and manipulates database to extract information for ad hoc reports, surveys, and internal and external provider directory extracts.
Adapts software as needed to facilitate efficient operation of credentials department and continuous quality improvement.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
This posting reflects an opening for Credentialing Coordinator II and we are seeking candidates for that position. Geisinger reserves the right to consider applicants for higher level of this role based on their skills, qualifications, and experience. We encourage all qualified individuals to apply.
Position Details:
Education:
High School Diploma or Equivalent (GED)- (Required) Experience:
Minimum of 4 years-Related work experience (Required) Certification(s) and License(s):
Skills:
Communication, Computer Literacy, Credentialing, Professional Presentation, Working Independently OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
EXCELLENCE: We treasure colleagues who humbly strive for excellence.
LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.
We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.