Credentialing Specialist
Company: PathGroup
Location: Nashville
Posted on: May 8, 2024
Job Description:
Job Description
JOB SUMMARY:
The Credentialing Specialist coordinates and completes hospital
credentialing documentation (initial applications and
reapplications) for all APII and/or PBM physicians; assisting in
the maintenance of physician databases (OneApp and Access);
maintains supporting documents for the physicians.
ESSENTIAL FUNCTIONS:
- Coordinate and complete all aspects of APII and/or PBM
physician credentialing for all contracted facilities, including
initial and reappointment applications, as directed by the
management.
- Assist in process for on-boarding new physicians and for
exiting physicians.
- Process upgrades, updates, edits, and deletions (programs)
within the physician credentialing databases.
- Coordinate and maintain records (electronic and paper files) on
all APII and/or PBM physicians.
- Compile QIP folders for each APII and/or PBM physician for
review by management.
- Maintain list of completed CME courses for each APII and/or PBM
physician.
- Assist with collecting, coding, and submission of physician
expense reports to Accounts Payable. This includes tracking CME
Fund totals.
- Perform all job responsibilities in alignment with the
industry's best security practices and regulatory guidelines to
protect the confidentiality, integrity, and availability of
protected health information and other sensitive company data.
- Become familiar with and abide by the Corporate Compliance
Program and all corporate policies, including the Privacy and
Security Policies.
- Administer quarterly and ad hoc APII physician Quality
Assurance reports from PathSys as requested by facilities.
- Coordinate the filing of AMA/PRA Certificate applications and
reapplications for APII physicians.
- Administrator for QGenda for APII physician scheduling to track
coverage and PTO.
- Assist with TMLT (Texas Medical Liability Trust) enrollment as
needed for PBM physicians.
- Assist with CLIA preparation and inspections as assigned for
PBM locations.
- Serve as primary point of contact for third party managed care
and medical billing for PBM physicians.
- Sort and distribute department mail.
- Work with other departments within PathGroup and
subsidiaries.
- Nothing in the job description restricts management's right to
assign or reassign duties and responsibilities to this job at any
time.
- Other duties as assigned.Requirements
EDUCATION LICENSURE:
- High School Diploma or G.E.D. is required.
- Three to four years of prior job-related credentialing
experience required.SKILLS AND QUALIFICATIONS:
- Knowledge of medical terminology, physician
credentialing/licensing, and previous database / document control
system experience strongly preferred.
- Strong communication skills. Must be able to effectively
communicate (oral and written) with all levels of personnel both
within and outside of the company.
- Demonstrate ability to perform tasks with a high degree of
accuracy and quality.
- Demonstrate ability to perform multiple tasks in a limited time
frame.
- Ability to exercise independent judgment under minimal
supervision; ability to function as a member of a team.
- Ability to comply with HIPAA regulations.
- Exhibit customer service focused skills.
- Must be able to assure confidentiality.
- Working knowledge of computer applications.
- Proficiency in use of MS Office products (Word, Excel,
Outlook).
Keywords: PathGroup, Clarksville , Credentialing Specialist, Other , Nashville, Tennessee
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