Dedicated to the Health of the Community
The Health Care District of Palm Beach County is an integrated public health system established in 1988 as a special taxing district that is an equal opportunity employer of approximately 1 , 000 employees. The Health Care District's mission is to ensure access to a comprehensive health care system and the delivery of quality services for the residents of Palm Beach County. The Health Care District provides challenging and fulfilling employment opportunities through its health coverage programs for uninsured residents, a nationally recognized Trauma System, a School Health program which staffs registered nurses in nearly 170 public schools, a pharmacy operation, a long-term skilled nursing and rehabilitation center, and its acute care hospital, Lakeside Medical Center, in rural western Palm Beach County.
General Statement of Job
This position provides coordination and completion of credentialing and re-credentialing activities on new or participating providers of all Health Care District programs. Employees in this position are responsible for review of applications, verification of credentials, maintenance of provider database, and the preparation of agendas and documentation for meetings.
Specific Duties and Responsibilities
Maintains knowledge of Medicaid prepaid health contract and other applicable contractual requirements for all lines of business.
Maintains knowledge of accrediting bodies’ requirements and recommend best practices.
Receives and reviews updates on credentialing. Escalates barriers to credentialing or re-credentialing process appropriately.
Communicates with applicants, providers, regulators, or potential delegation groups.
Communicates interdepartmentally to facilitate work flow, to collaborate with peers, and to support a team environment.
Receives and reviews pre-screening applications on providers for the purpose of determining if providers meet minimum requirements.
Reviews applications to ensure applications are complete with required documentation and to determine if providers meet credentialing criteria.
Evaluates and routes applications through appropriate verification source.
Reviews provider contracts to ensure adherence to stipulations and credentialing criteria.
Contacts hospitals and/or appropriate agencies for the purpose of verifying information.
Prepares files and documentation for timely presentation and review by the Medical Director and the Credentialing Subcommittee.
Attends and provides support for Committee meetings.
Communicates and prepares correspondence to providers concerning results of application and re-credentialing review.
Maintains integrity, confidentiality, up to date and accuracy of computer records and documentation concerning applications, credentialing information, and related criteria.
Coordinates dissemination of information concerning providers from all departments to facilitate peer review.
Performs timely reviews of disciplinary action reports issued by State licensure bodies, Medicaid, and other agencies as appropriate. Escalates issues or concerns appropriately.
Maintains knowledge of verification sources contract.
Performs investigative and research duties in relation to function under charge for verification purposes.
Produces regularly scheduled and ad hoc reports.
Performs random audits of files from verification source.
Participates in Plan audits by outside regulators including but not limited to AHCA, DOH, CMS, AAAHC, or designated agency.
Emergency duty may be required of the incumbent that includes working in Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or disasters, man-made or natural.
This job description reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. The omission of specific statements of duties does not exclude them from the position. Management of the Health Care District of Palm Beach County reserves the right to assign duties not listed herein as necessary to accomplish the goals of the organization.
Associate’s degree with course work emphasis in the medical or health care field required.
Two (2) or more years progressively responsible experience in the field of credentialing, to include broad knowledge of managed care organization operations and significant interaction with health/medical care providers required.
Provider Credentialing Specialist Certification preferred.
Valid Florida Driver’s License required.
The Health Care District is an Equal Employment Opportunity Employer and maintains a Drug Free Workplace. Qualified individuals with disabilities who require an accommodation to participate in the application process should contact Human Resources. Veterans preferred.
The Health Care District of Palm Beach County is an integrated public health system established in 1988 as a special taxing district that is...