PROVIDER RELATIONS PRIVILEGING AND LICENSING

Nevada Health Centers I•Carson City, NV

25d

About The Position

Supports all aspects of provider relations with clinical staff in a non-profit health care setting for designated business unit(s). Nevada Health Centers is an employer of choice and offers comprehensive benefits, including but not limited to: Competitive compensation, with annual merit increases Company sponsored PPO medical plan and buy-up option, vision, and dental plans 403(b) retirement plan with employer match Generous time-off policy, and ten (10) paid holidays plus one (1) float holiday Company paid life/AD&D and long-term disability policies

Requirements

Bachelor’s degree
Minimum of 3 to 5 years of credentialing and privileging experience or similar relevant experience

Nice To Haves

Working knowledge of Microsoft Word, Excel and PowerPoint
Working knowledge of DocuSign
Working knowledge of basic computer file systems, naming conventions, and organization
Ability to take direction and be well organized
Ability to communicate in a courteous and professional manner
Ability to work and interact effectively and positively with other staff members to build and to enhance teamwork in the clinics and overall NVHC organization
Skill in communicating effectively, both in oral and written form, to individuals and groups
Skill in accuracy and attention to detail
Ability to maintain confidentiality of information
Ability to solve practical problems and deal with a variety of variables
Ability to understand and respond appropriately, effectively, and sensitively to special population groups as defined by race, ethnicity, language, age, sex, etc.
Ability to work and interact effectively and positively with all levels of staff to build and enhance teamwork in the clinics and in the overall NVHC organization
Ability to address multiple priorities; manage time and complete work in a timely and accurate manner while under the pressure of meeting deadlines
Ability to handle stressful situations appropriately
Ability to work independently
Problem solving
Ability to come to logical conclusions
Ability to work proactively and identify issues before they become problematic
Demonstrated ability to maintain confidentiality
Flexible to handle unexpected daily challenges
Knowledge of credentialing and privileging rules and regulations
Knowledge of Medicare, Medicaid, and private insurance
Knowledge of basic healthcare compliance fundamentals
Knowledge of basic medical practices and terminology
Represents organization in a positive and professional manner

Responsibilities

Manages credentialing and Medicare/Medicaid revalidations for NVHC health clinic locations
Manages and maintains all credentialing and privileging files for non-provider clinical staff as required by Health Resource and Service Administration (HRSA).
Responsible for the compliance of all OCLP and OCS credentialing files
Working in partnership with Human Resources: 1. Monitors for new clinical hires, 2. Partners with Human Resources for gathering of required paperwork and information for credentialing files, 3. Partners with Human Resources for ongoing credentialing paperwork needs
Manages queries of state and national websites for new clinical staff to verify eligibility for employment, licenses, certifications, and/or registration
Manages queries of national websites to ensure that NPDB and OIG queries are completed and reviewed prior to employment of clinical staff, reports any findings to the Provider Relations manager in a timely fashion
Maintains knowledge of HRSA regulations and changes in compliance
Manages new PINs and PALs and reports any updates to Provider Relations team
Monitors licensure end dates and informs clinical staff of need for renewals
Monitors new hires for training completion and ensures that training documentation is complete, signed, and part of the employee’s credentialing file
Works with clinical leadership to obtain documentation of competency and fitness for duty
Prepares credentialing files for initial privileging
Manages reappointment processes, monitors expiration dates and ensures that reappointments are completed in a timely manner
Works with clinical staff members to request necessary documentation and to compile reappointment requests
Answers staff questions related to credentialing and privileging
Assists with management of CME requests and tracking of CME costs and requirements and assists with enrollments into requested CME courses
Assists with the purchase and tracking of provider subscriptions and memberships
Manages the student process and onboarding/offboarding of students in structured shadowing programs
Assists with management of enrollments for LIP as requested
Provides feedback on processes and participates in process improvement within the Provider Relations team
Performs other work-related duties as requested by supervisor
Complies with all aspects of the Standards of Behavior
Supports the Provider Relations team as needed