Sr. Credentialing Specialist

Fresenius Medical Care•Kennesaw, GA

About The Position

This role collaborates with a third-party external credentialing agent to ensure the credentialing process is completed as required. It ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards, as well as internal FMCNA policy and procedure. The position performs audits of both the internal FMCNA Provider Database and FMCNA provider information compiled by the external credential verification agent to ensure timely completion of credential verification according to all regulatory and company requirements.

Requirements

Bachelor's Degree required
0 - 2 years' related experience
Strong detail orientation required, with the ability to administer multiple tasks and prioritize.
Excellent verbal and written communication skills.
Ability to positively interact with Providers, hospital personnel, and other internal and external contacts.
Perform work at a high level of accuracy and timelines.
Attention to confidentiality and regard for protecting confidential and sensitive information.
Advanced level skills with Microsoft Access, Excel, and Word.
Strong problem solving and time management skills with the ability to consistently work in a fast-paced environment.
Strong Excel, data-base management, and document storage and management skills.

Responsibilities

Performs provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff by-laws regarding the verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment.
Responsible for tasks related to the three-year cyclical verification process of all active practitioners.
Utilizes knowledge regarding national accreditation standards, internal medical staff bylaws and other related policies and regulations to perform functions pertaining to the provider/practitioner credentialing process for the FMS Division.
Obtains practitioner license information from publicly available state/government agency websites, the National Provider Databank, and other 3rd party certification groups such as the American Board of Internal Medicine.
Completes and processes all initial credential applications for new providers/practitioners and credential verification applications for existing providers/practitioners in a timely and accurate manner.
Conducts follow-up as needed, acting as the primary liaison for FMCNA locations, practitioners, and the FMCNA third-party credentialing agent to ensure that all credentialing is completed within the required timelines and that each provider/practitioner meets federal and state regulations as well as FMCNA internal requirements.
Maintains and updates the database on individual provider/practitioner credentials' status, tracking pending/completed applications, and maintaining a complete and accurate database of historical applications.
Provides regular reports and updates to pertinent FMS field operations management and Director Operation Monitoring.
Communicates with practitioners regarding credentialing status, providing updates and obtaining additional information as required.
Educates and informs FMS field staff responsible for reporting new practitioners regarding their responsibilities in the credential verification process.
Explains the credentialing requirements, practitioner specific information, information regarding the FMCNA third-party credential agent, regulations and industry standards for credentialing of health care providers and other information as applicable.
Continually audits and analyzes the credentialing process to identify deficiencies in controls and to identify process/workflow issues recommending improvements to manager and implementing if approved.
Reviews internal Provider Database information and database of FMCNA provider information compiled by external credential verification agent to identify and take appropriate action where required to correct areas of noncompliance with company policy, such as reporting requirements of identified deficiencies in provider applications, reporting of providers non-compliant with verification policies, expired board certifications and other requirements as applicable.
Responsible for generating various standard and ad hoc reports from database.
Prepares project status reports as required, detailing progress of credential verification status of individual practitioner credential applications for each FMS Division, and reporting variances and trends in the credentialing process as identified to the Director Operations Monitoring.
Prepares reports detailing credential verification issues to pertinent field staff and credential verification agent.
Prepares the monthly provider/practitioner credentialing status report for review by Director Operations Monitoring.
Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
Assists with various projects as assigned by direct supervisor.
Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations.