Location: Corporate – Bakersfield
Job Summary: Under the direction of the Credentialing Supervisor and in accordance with Omni Family Health (OFH) Policies and Procedures, this position is a key part of the team responsible for the initial and ongoing credentialing process of all new and established medical and dental providers including obtaining privileges at all appropriate hospitals and health plans. Tracks all re-credentialing, prepares and submits required forms, gathers needed documentation and information. Maintains current knowledge of eligibility and enrollment requirements and communicates changes to Credentialing Supervisor and affected staff. This position may provide support to the overall human resources team in various duties and/or projects.
- Supports the overall goals and objectives of OFH, by ensuring the existing and new providers are both privileged to see OFH patients and payer credentialed to the different plans and insurances taken by OFH. This is done with the timely submission and updating credentialing applications and licenses to all necessary agencies for providers prior to their start date. This position may be asked to submit application/documentation for hospital privileges to necessary agencies such that providers may see patients at OFH facilities.
- Responsible in ensuring OFH provider participation in programs meets with expected guidelines when processing applications as regulated under contract, federal and/or state law or any other agencies.
- Supports the team by assist with reviewing credentials of providers to ensure that all documentation has been obtained, reviewed and verified and meets with OFH’s policy and procedures for credentialing and general standards as set by JCAHO and National Association of Medical Staff Services (NAMSS).
- Supports the ease of communication and team support by consistently maintain credentialing files for Dental, Medical physicians, mid-level providers, and updating as necessary or required.
- May be required to attend management/staff meetings and committee meetings, take notes and prepare meeting minutes as per OFH policies or as directed.
- May be requested to assist the Credentialing Supervisor in scheduling and/or arranging for meetings and appointments affecting the work of the area. Supports the easy facilitation of meetings by ensuring that files to be reviewed or presented are accurate and organized for easy review.
- Supports the work of the OFH by responding to information requests in a timely manner. Additionally, this position may be directed by the Credentialing Supervisor and/or HR management personnel to handle requests for copies of credentialing records or other data requests from other departments and/or areas.
- Assists the OFH team by researching questions, making calls and answering requests for information appropriate to information and areas within the functions of credentialing. Expected to respond to correspondence and distributes to information to appropriate individuals.
- Supports the work of the area and department by monitoring and conducting regular follow up on outstanding credentialing applications. Assists the Credentialing Supervisor by communicating the status of each application assigned as well as assure proper completion and accurate of credentialing reports and/or logs.
- Responsible for supporting the Credentialing Supervisor by assisting with the preparation of corporate applications to various programs, such as Medicare, CHDP, VFC, EWC, Family Pact, CPSP, Medi-Cal, Kern Health, IMG, BFMC, etc.
- Within the purview of the work assigned, this position is responsible for requesting malpractice insurance policies, updating any internal tracking system.
- Responsible for management of provider credentials to ensure that current and active documents are on file. Is responsible for communicating with providers regarding missing or soon to expire credentials and requesting documents.
- Expected to perform clerical functions such as creating letters and memos, create and maintain spreadsheets and distributes correspondence to staff and business partners.
- HIPAA compliance – Responsible for maintaining abreast of and in compliance with all regulations and requirements as defined under the Health Insurance Portability and Accountability Act (HIPAA). Is expected to treat all OFH team member’s information as sensitive and confidential.
- Compliance – Expected to ensure compliance with all local, state and federal regulations.
- All employees will participate in Patient Centered Health Home Model at Omni Family Health
- QA/QI – Required to participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- Promotes Omni Family Health mission statement, ethics and values through communication, action, and behavior. Expected to demonstrate awareness of, and compliance with, organizational objectives of OFH in providing quality health care access services for all members of the community.
- Performs other work-related duties as assigned by supervisor; duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
Qualifications: Education, Skills and Experience
- EDUCATION: Minimum high school diploma or equivalent; AA/AS degree or Credentialing Specialist (CPCS) certification preferred.
- EXPERIENCE: Minimum of 2 years’ experience working within the credentialing area of a hospital/health center medical support department or two (2) years of experience as a biller in a healthcare setting (similar position may also be considered as substitute for credentialing experience depending on the level of experience).
- Proficient with computers systems, networks and software applications (MS Word, Excel) as word processors and spreadsheets required. Ability to learn and adapt to technology innovations newly introduced to the work environment.
- Knowledge of office procedures and familiarity with using general office equipment (e.g., copiers, scanners, fax, etc.)
- Be committed to providing superior customer attention and service at all times at every point of human contact. Ability to anticipate the needs of the customer and deliver on expectations consistently.
- Ability to communicate effectively in conveying information and/or ideas across all modes of communication (e.g., email, letter writing, telephone conversations, etc.) to internal and external customers.
- Ability to organize and approach work independently to meet deadlines and possess time management skills.
- Ability to work quickly and accurately and balance work load against shifting priorities and do so while maintaining a positive outlook and approach.
Responsible To: Credentialing Supervisor
Classification: Full Time Position, Non-Exempt