Job description
Overview:
Provider Enrollment:
Administrative Duties:
This position is responsible for 1) facilitating and tracking credentialing and privileging for all licensed and/or certified providers at Jemez Health and Human Services (JHHS); 2) assisting with the coordination and tracking of staff trainings; 3) facilitating general onboarding of new hires and, 4) assisting the Business Office with maintaining insurance contracts between the insurance companies and providers billing to them.
Responsibilities:
Credentialing:
- Complies with all elements of the JHHS credentialing and insurance enrollment activities related to all medical staff by conducting primary source verification and outside agency queries. This includes but is not limited to the data entry portion of the process, initial credentialing, re-credentialing, additional privileges, modification of privileges, change of departmental assignment or other credentialing/privileging activities and insurance enrollment for all lines of business.
- Follows policies and procedures to facilitate the process to ensure that licensed and certified providers are thoroughly credentialed, privileged, and re-appointed, meeting required time frames, including review and approval by the JHHS Director, Medical Director, Medical Executive Committee, and Health Board
- Complies with legal, regulatory and accreditation requirements relevant to credentialing.
- Verifies credentials using primary or secondary sources as applicable, monitors’ time sensitive and/or expiring credentials, maintains a review schedule, prepares credentialing reports for privileging and re-privileging deliberations, and maintains credentialing files.
- Answers inquiries regarding providers’ credential status and works with colleagues to ensure accuracy of all files by tracking the expiration of licenses and certifications to ensure timely renewals.
- Upon a new provider’s completion of credentialing, notifies the following staff of completion: JHHS Director, Compliance Officer, Medical Director, Managers, and Human Resources representatives; in addition, provides credentialing-status updates to the above employees.
- Responsible for the organization, maintenance, and accuracy of medical staff data on hard copy files and electronic employee credentialing system (i.e. VerityStream).
- Analyzes and resolves provider file issues.
- Perform administrative and technical duties necessary to complete credentialing functions in accordance with JHHS bylaws.
- Maintains all credentialing files in accordance to HRSA and AAACH guidelines.
Provider Enrollment:
- Assists the Business Office with maintaining insurance contracts for providers by obtaining and providing required information, such that providers are approved and included so that they can bill.
Trainings:
- Initiates and coordinates onboarding for new employees for JHHS, and ensuring back-up if not available.
- Responsible for orientation/training of new and current employees as it relates to departmental procedures, credentialing database, and daily work.
- Ensures mandatory trainings are completed within the required time for compliance.
- Maintains training logs of all department employees.
- Assign mandatory trainings for all staff in the training system (Healthstream).
Administrative Duties:
- Participates in audits that may occur from insurance companies or accreditation organizations.
- Schedules and arranges for Medical Executive Committee meetings, including timely completion of minutes.
- Organizes own work, sets priorities, and meets critical deadlines.
- Contributes to the overall quality of JHHS by developing and coordinating work teams and by reviewing, recommending, and implementing improved policies and procedures.
- Represents the Pueblo of Jemez with dignity, integrity, and a spirit of cooperation in all relationships with the staff and public.
- Other duties as assigned.
High school diploma or general equivalency diploma (GED); AND minimum one (1) year of office support, medical reception, administrative experience or other support service in a healthcare setting.
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