Credentialing Specialist

Legacy Health•Portland, OR

5h•$24 - $34•Remote

About The Position

A single mission drives everything we do at Legacy: to make life better for our patients, our staff and the community. It’s a tall order, but one we best accomplish by creating a team of professionals who are passionate about what they do and who want to make a difference. This extends to every area of the Legacy community, including clerical and administrative. If you are a Credentialing Specialist who believes that your expertise can enhance the Legacy mission, we’d like to talk to you. Credentialing Specialists work in the System-Wide Centralized Verification Services or Professional Billing Services Departments and are responsible for providing verification and quality control functions to support Legacy Health’s goals for credentialing health care practitioners while ensuring adherence to legal, regulatory and delegated credentialing requirements.

Requirements

High school education. Some college desirable.
Minimum two years relevant credentialing experience or equivalent, preferably in a like setting such as a health plan, clinic or hospital.
Excellent organizational skills.
Ability to handle large volume of work.
Excellent computer and word processing skills.
Knowledge of privacy laws, regulations and national standards related to health plan credentialing and/or Medical Staff Services.
Excellent communication skills

Nice To Haves

Certification as Certified Provider Credentialing Specialist preferred.

Responsibilities

Coordinates or processes initial credentialing and recredentialing.
Coordinates and administers the credentialing and/or privileging practitioner associated with Legacy Health to ensure that valid and timely information is provided for practitioner credentialing decisions.
Conducts primary source verifications and collects other elements for all applicants according to established policies and procedures
Prepares or assists in preparing initial credentialing/appointment and recredentialing/reappointment information for review by appropriate committees
Reviews all submitted information for accuracy and identifies problem areas for additional attention. Notifies applicable parties of issues, as appropriate.
Obtains required signatures.
Follows up on all incomplete or problematic information.
Uses critical thinking skills while performing credentialing to flag incongruent issues or information as they arise.
Maintains database.
Enters all information into the MSOW or Apogee database.
Responsible for generating reports and creating correspondence.
Receives and inputs all changes impacting providers.
Populates, updates and verifies correctness and completeness of database information on an ongoing basis.
Ensures integrity of database including what is provided to other departments.
Prepares and provides documentation necessary to enroll practitioners with health plans.
Prepares client advisory reports including but not limited to status reports, expired items reports and completed file reports to assure contractual time frames are met.
Conducts any additional health plan specific checks required by Health Plans.
Operates computer, copy machine, fax and other office equipment efficiently.
Maintains working knowledge of changes and upgrades in computer programs.
Demonstrates knowledge and appropriate use of department systems.
Files all pertinent information in credentials file (electronic or hard copy).
Maintains confidentiality in file maintenance.
Keeps files accurate and up-to-date.
Responds to customer inquiries and resolves problems in accordance with policies and procedures.
Adheres to standards established within the department in accordance with legal, department and health system policies.
Ensures information is processed as required by accrediting bodies such as the Joint Commission, NCQA, URAC, CMS, as well as State and federal law.
May provide meeting support for the Managed Care Committee as assigned. This includes scheduling meetings, preparing agendas, taking meeting minutes and providing post-meeting follow through.
Takes responsibility for personal professional development through self-study and participating in in-services and continuing education programs provided by department.
Maintains current knowledge of regulatory requirements regarding credentialing and privileging, as well as system and department policy.
Actively participates in quality improvement activities and may participate in system-wide department initiatives or projects, as assigned.