Credentialing Associate

Job Number 68656
Posted 2/19/2020
Account Northern Light Health Home Office
Department Credentialing
Location |ME| Northern Light Health Home Office - Douglas Brown Bldg., Ban, ME 04401
Schedule Regular Full-time
Shift Day
Hours 8-4:30
Job Details Job Summary

The Credentialing Associate is responsible for all aspects of the credentialing for providers that need to be appointed and/or reappointed as part of their relationship with EMHS and its member organizations. Responsible for ensuring credentialing documentation has been secured, primary source verified, analyzed and delivered on behalf of EMHS in a timely fashion. This position will credential a variety of provider types and will need to manage a large volume of applications while maintaining the integrity of each application. The position will be responsible to follow all applicable regulations and accrediting body guidelines.

Job Functions and Duties

-Compiles and maintains current and accurate data for all providers

-Completes provider credentialing for appointment and/or reappointment, monitors applications and follows-up as needed

-Completes primary source verification process for all EMHS providers, in accordance with, TJC, HFAP, and CMS accreditation standards, Federal and State laws, and EMHS policies.

-Maintains providers credentialing data electronically via EMHS credentialing software, shared computer files and/or CAQH (Council for Affordable Quality Healthcare)

-Work closely with department's provider enrollment staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.

-Establish close working relationships within department and with various departments across system

-Processes and distributes appropriate correspondence

-Maintains working knowledge of applicable regulations, policies and procedures.

-Represents the office to internal and external customers as appropriate

Performs miscellaneous job-related duties as assigned.

Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.

Required Education and Experience:

-High school diploma/equivalent; associate's strongly preferred.

-General understanding of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards.

-Experience with Microsoft Office products, including but not limited to Excel and Outlook

Preferred Education and Experience:

-Bachelor's degree

-At least 2 years of medical office experience
NAMSS Certification as a Certified Provider Credentials Specialist (CPCS)

-NAMSS Certification as either Certified Professional Medical Services Manager (CPMSM)

-Affiliation and participation with the Maine Association Medical Staff Services

-Affiliation and participation with the National Association Medical Staff Services

Knowledge, Skills, and Abilities

-Excellent attention to details

-Ability to research and analyze documents.

-Ability to work independently, set priorities and meet deadlines with minimal supervision

-Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products and HealthLine Systems ECHO credentialing software preferred.

-Ability to communicate effectively, both orally and in writing.

-Must be able to communicate well with a wide variety of contacts at all levels of the organization.

-Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.

-Ability to maintain confidentiality, work with deadlines and manage multiple priorities.

-Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.

-General understanding of related accreditation and certification requirements.

-General understanding of medical credentialing and privileging procedures and standards.

-General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

Supervision Received (ability to act independently)

Reports to the Credentialing and Provider Enrollment Manager. Must be an organized "self-starter" requiring little supervision in order to focus on and accomplish tasks by assigned deadlines.

Typical Contacts (Internal/External)

All levels of customers (internal and external to EMHS) including peers, leadership, clinical and administrative staff.

Physical Requirements

• Works in a normal office environment, requiring the ability to frequently respond to unpredictable situations. Time may be spent sitting at a computer, collaborating with other healthcare team members. Able to work sitting at work station, using a keyboard, working in front of a video display monitor most of the day.

• Repetitive wrist and hand motion.

• Extended use of telephone.

• The ability to reach and stretch intermittently.

• Moderate walking throughout the facility.

• Light lifting of files and manuals

• Occasional long and irregular hours

• Must be willing to travel by air and ground.

• Tolerance for frequent interruptions

• Flexibility, dexterity, visual acuity, hearing acuity.

• Must be able to speak and communicate clearly and effectively.

• Must be able to adapt to frequently changing work priorities.

• Must be able to travel to various EMHS/non-EMHS sites as there will be occasional travel for off-site meetings, education and/or conference(s).

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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