Credentialing Specialist

SUMMARY:

Provide credentialing support to HR Manager and Executive Administrative Coordinator.

CORE RESPONSIBILITIES

  • Respect and maintain patient confidentiality in all aspects of care including use of electronic information.  
  • Treat all patients and fellow staff in a welcoming and professional manner.
  • Demonstrate professionalism by appropriate attire, attendance, attitude and behavior within the department setting. 
  • Contribute to the team effort by supporting all team members and maintaining an open and positive attitude
  • Welcome new facility staff to the team by assisting with their orientation to the team and mentoring them as requested.

DUTIES AND RESPONSIBILITIES

  • Coordinate credentialing of all licensed medical and behavioral health staff.  Develop process and maintain credentialing files to assure credentialing process is complete before new provider begins.  
  • Send reappointment information to current providers approx. 3 months before re-appointment date, meet with Executive Committee monthly for approval of new provider staff and re-appointments, monitor expiration of all licenses/credentials of licensed staff.
  • Maintains up-to-date information from licensed clinicians (MD, NP, PA, Dentists, RN’s, etc.) monitoring expiration of all licenses/credentials for licensed staff.
  • Maintains enrollment transactions and manages affiliations with 3rd party payors for all Health Center sites.
  • Maintains all credentialing and recredentialing for new provider affiliations and terminations with 3rd party payors for LCHC clinicians (MD, NP, PA) ensuring completion according to time standards.
  • Monitor credentialing issues and resolve to track progress of transactions.
  • Respond to all requests from 3rd party payors in a timely manner.
  • Maintains CAQH database and provide maintenance services to all providers.
  • Assists with credentialing for Medical, Behavioral Health, Eye Care, and Dental as needed.
  • Sustains administrative filing system, updating when needed, and updating compiled data in system.
  • Assists with administrative projects, researching and preparing other reports.
  • Back up administration assistants when needed.

Customer Service:

  • Demonstrates an understanding of customer service principles by successfully completing on-line Customer Service training and ACES Training.
  • Utilizes the principles of customer service when interacting with patients/clients, team members and staff from other departments. 
  • Appropriately handles or seeks support when customer service breakdowns occur.

Cultural Competence:

  • Demonstrates knowledge of culture by successfully completing the on-line training on Cultural Competence. 
  • Utilizes an appreciation of and respect for diversity when interacting with patients/clients, team members and staff from other departments. 
  • Responds appropriately or seeks support when confronted with cultural biases or conflicts.

Emergency Situations:

  • In order to respond promptly and appropriately to emergency situations, any staff member may be assigned temporary duties which differ from those in the job description, or may be assigned temporarily to a different location or schedule. 
  • Understands that all staff should have a personal emergency plan in place to best respond to his/she job responsibilities should health center emergency arise 

SUPERVISION RECEIVED:

  • Under the general supervision of the HR Manager with latitude given for independent judgment and decision-making.

Requirements

QUALIFICATIONS:

  • Strong communication, interpersonal, organizational, and secretarial skills. 
  • At least five years experience in comparable position, preferably in a health care environment. 
  • High School Diploma or equivalent and proficient in word, excel, and other office computer applications. 
  • Ability to deal discreetly with confidential matters.

SPECIAL REQUIREMENTS:

  • The essential job duties of this position present risk of exposure to bodily fluids and blood borne pathogens.  Annual attendance at LCHC Bloodborne pathogen training is required.  
  • Up to date immunizations and annual TB testing is required.  
  • Hepatitis B vaccine and annual flu immunization are strongly recommended and available at no charge at the Health Center.  Declination form must be signed if Hepatitis B vaccine is declined.
  • Results of inquiry to Criminal Offender Record Investigation (CORI) must be acceptable under health center standards.

Lynn Community Health Center (LCHC) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, LCHC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation and training. LCHC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of LCHC’s employees to perform their job duties may result in discipline up to and including discharge. 

Job Posting ID: 18-167 (Part time 25-40 hours)

Hours

Part-Time