Health Plan Credentialing - CME Specialist
About The Position
Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. General Purpose of Job: The Health Plan Credentialing - Continuing Medical Education (CME) Specialist is responsible for carrying out the functions of the Driscoll Health Plan's Health Maintenance Organization (HMO) credentialing process. Additionally provides support and assistance for other medical staff and provider relations activities. Confidentiality is a key responsibility. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required. Maintains utmost level of confidentiality at all times. Adheres to DHS/DHP policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Processes applications both medical staff and applicable allied health professionals for credentialing and recredentialing Processes requests for temporary privileges Prepares confidential correspondence Oversees, develops and maintains credentialing database program Maintains all credentials files Prepares credentialing profiles and reports Monitors database for expirations of required credentials, securing current verification of licensure, DEA, and DPS registrations and professional liability insurance Oversees and maintains privilege delineation system Prepares medical staff roster Monitors state and federal sanctions reports Oversight of all provider data to be published in GeoAccess prepared provider manuals
Requirements
- Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one-year related experience and/or training; or equivalent combination of education and experience.
Nice To Haves
- Credentialing and/or Health Plan/HMO experience along with computer skills to include Intellicred is a plus.
Responsibilities
- Maintains utmost level of confidentiality at all times.
- Adheres to DHS/DHP policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Processes applications both medical staff and applicable allied health professionals for credentialing and recredentialing
- Processes requests for temporary privileges
- Prepares confidential correspondence
- Oversees, develops and maintains credentialing database program
- Maintains all credentials files
- Prepares credentialing profiles and reports
- Monitors database for expirations of required credentials, securing current verification of licensure, DEA, and DPS registrations and professional liability insurance
- Oversees and maintains privilege delineation system
- Prepares medical staff roster
- Monitors state and federal sanctions reports
- Oversight of all provider data to be published in GeoAccess prepared provider manuals
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
