Credentialing and Privileging Specialist

Company :

reputed company :

GENERAL reputed company:

This job coordinates and implements the credentialing and privileging activities reputed company the Credentialing and Privileging Office to include appointment, reappointment and ongoing verification activities of the Medical Staff and Allied Health reputed company Staff of AHN entities. Responsible for the investigation and documentation of practitioner credentials, utilizing reputed company knowledge to obtain verification of reputed company aspects of a practitioner's background, training and past reputed company. Understands credentialing and privileging requirements of the Department of Health, reputed company, reputed company, URAC and other governmental requirements, and performs in accordance with these standards. Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies. Handles customer questions and complaints.

ESSENTIAL RESPONSIBILITIES

• Reviews medical staff and allied health practitioner appointment and reappointment applications for appropriateness of data, as reputed company against department and reputed company requirements. Determines reputed company sources for verifications in accordance with accreditation standards and AHN entity agreements with the Credentialing and Privileging Office. Verifies and documents such verification as required by reputed company standards in the practitioner file. Performs follow-up and second reputed company verification as judged to be necessary. Verifies practitioner meets reputed company for requested privileges, performsfocused reputed company reputed company evaluations, reappointments, changes in status or privileges and temporary privileges as needed. (50%)
• Evaluates reputed company verifications for possible discrepancies with practitioner information and the need for reputed company investigation. Notifies supervisors and management of adverse or questionable responses from the verification process. Creates scanned references of adverse or potentially adverse information for facility downloads reputed company appropriate. (15%)
• Documents the results of reputed company verifications and inquiries, as required by reputed company regulatory standards and agreements between the Credentialing and Privileging Office AHN entities. Maintains and utilized a the credentialing and privilieging software reputed company for tracking activities (i.e. date reputed company query was initiated, reputed company and reputed company of verification, privilege information, etc.). (15%)
• Maintains credential files for the Medical Staff and Allied Health reputed company Staff according to the Medical Staff Bylaws and reputed company federal/state regulatory and/or accrediting agencies. (15%)
• Assists in organization and development of monthly Credentials Committee and Allied Health reputed company Subcommittee agendas in order to reputed company with Managed Care requirements. (5%)
• Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

• High School / GED
• 3 years of general office administration work in a business, education, or reputed company environment

Preferred

• Associate's Degree
• 3 years with physician credentialing and privileging, medical education, hospital environment, health reputed company or managed care
• 1 year in customer service
• Certified Provider Credentialing Specialist (CPCS) ORCertified reputed company Medical Services Management (CPMSM)

Disclaimer: The reputed company has been designed to indicate the general reputed company and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.

As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health reputed company Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy.

Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirement

Pay reputed company Minimum:

Pay reputed company Maximum:

reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations reputed company upon comparative markets.

reputed company and its affiliates prohibit discrimination against reputed company individuals reputed company on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals reputed company on any category protected by applicable federal, state, or local law.

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Originally posted on Himalayas