One Health Hiring for Credentialing Specialist at Hardin, Montana Full Time

Credentialing Specialist Business and Finance · Hardin, Montana

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Department Business and Finance

Employment Type Full-Time

Compensation $17.25-$18.33 DOE

With multiple clinic sites across Montana and Wyoming, One Health provides medical, dental, pharmacy, behavioral health, and community and public health services to rural populations through an integrated approach to health care.

One Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Benefits : We offer a competitive compensation package that includes paid time off, nine paid holidays, discounted health care for employees and their family members, as well as health, dental, & vision insurance, disability insurance, health savings account, and matching retirement plan for all employees working at least 20 hours/week.

POSITION SUMMARY: Responsible for all aspects of the credentialing, re-credentialing, privileging, reviewing and onboarding processes for all licensed individual practitioners (LIPs), other licensed or certified practitioners (OLCPs), and other clinical staff of One Health. Responsible for ensuring LIPs are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Responsible for ensuring OLCPs are credentialed following Health Resources and Services Administration’s (HRSA) guidelines. Maintains up-to-date data for each LIP, OLCP and other clinical staff in credentialing file and system. Ensures timely renewal of licenses and certifications.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

• Compiles and maintains current and accurate data for all healthcare providers.

• Completes provider credentialing, re-credentialing, privileging, and onboarding applications; monitors applications and follows up as needed.

• Maintains copies of current state licenses, DEA (drug enforcement administration) certificates, BLS (Basic Life Support), malpractice coverage, and any other required credentialing documents for all practitioners and other clinical staff.

• Maintains knowledge of current health plan and agency requirements for credentialing providers.

• Tracks license and certification expirations for all LIPS, OLCPs and other clinical staff to ensure timely renewals.

• Responsible for distributing and tracking quarterly provider peer reviews for compliance of Internal Peer Review Program.

• Processes applications for appointment and reappointment of privileges.

• Auditing paperwork such as applications and licensing documentation for accuracy

• Maintains Credentialing tasks in billing software.

• Maintains provider’s CAQH accounts.

• Maintains confidentiality of provider information.

• Understand current healthcare laws and regulations.

• Adheres to all One Health Policies and Procedures

• Participates in performance optimization and risk management activities as required.

• Cooperates and abides by all elements of One Health’s Compliance Program.

• Provides exceptional customer service and models the mission of One Health when interacting with internal and external stakeholders promoting a positive image for the health center.

• Performs other duties as assigned or required with or without prior notification.

  MINIMUM JOB QUALIFICATIONS:

  Education/Certificates/Licenses:

  Required

• High school diplomas or GED

• Valid driver’s license

  Preferred

• Associate degree in medical staff services studies, or a related field.

• Certified Provider Credentialing Specialist (CPCS)

  Experience:

  Required

• Two years of relevant credentialing experience