Under general direction, process Oklahoma Physicians Association (OPA) provider initial and reappointment applications.
Responsible for processing Oklahoma Physicians Association provider initial and reappointment applications in accordance with National Committee for Quality Assurance (NCQA) credentialing standards. Maintains credentialing database and individual credentialing files. Keeps apprised of current NCQA standards as well as legal standards related to the credentialing of Physicians and Physician Extenders. Obtains primary source verification as required by OPA credentialing policies and procedures. Runs reports and queries as required by the various health plans. Prepares recredentialing packets. Reviews applications based on the policies and procedures required by NCQA, OPA and the State of Oklahoma. Prepares credentialing documents for the Board of Directors and Credentialing Committee members. Takes minutes at the Board of Director meetings. Updates credentialing information on the OPA's database. Notifies health plans of provider additions, terms and changes. Keeps track of health plan effective dates for new providers. Performs as liaison in answering provider questions regarding health plan status. Assists with annual health plan credentialing audits
Two (2) years credentialing experience in a health care setting.
Physical Requirements (with or without accommodation):
Requires sitting for long periods. Sufficient hand coordination to operate computer and other equipment. Sufficient visual acuity to read reports and computer screen. Performs repetitive tasks and motions for up to 6 hours per day. May occasionally be required to reach above head, twist at waist and/or lift items. May be required to lift/carry items weighing up to 25 pounds.
Knowledge, Skills and Abilities:
Knowledge of standards and legal requirements related to physician credentialing. Excellent computer skills to include knowledge of Access Database. Excellent verbal and written communication skills. Excellent organizational skills. Ability to work effectively with agencies and health plan providers. Ability to maintain confidentiality. Skill in performing detailed worked. Ability to work on a variety of tasks and to change priorities quickly.
HCA Inc - 17 months ago