Credentials Specialist -
Chenega Corporation - San Antonio, TX

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A Credentials Specialist verifies all of the credentials of
incoming healthcare providers, utilizing their knowledge of regulatory
standards and the requirements to remain compliant, and allow the provider to
obtain and maintain privileges.

Essential Duties and
Responsibilities

Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions of this
position

1.
Send credentialing packet to provider

2.
Communicate to provider all credentialing
policies, procedures, protocols, and time restraints

3.
Verify all necessary credentials i.e. licenses,
certifications, back ground checks

4.
Partner with provider to ensure accuracy and
completion of all forms completed within time restraints

5.
Contact medical office staff/MTF, licensing
agencies, insurance carriers, educational institutions, and previous employers
for verifications to complete credentialing and re-credentialing applications.

6.
Work with Program Management to ensure timely
start for provider.

7.
Assist in the streamlining of department
policies and procedures and workflows to create and maintain replicable
processes within the department.

8.
Run regular reports, to ensure up-to-date
licensures, and certifications

9.
Track all required information in database or
excel spreadsheet.

10. Assist
in preliminary back ground checks, to assist recruiting in potential candidate

11. Research
classes/courses in the community when needed i.e. BLS, ACLS, etc.

12. Keep
manager informed of concerns or problems with provider or credentialing packet

13. Maintain
current knowledge of state guidelines and regulatory requirements as well as
maintain current knowledge of the credentialing process and applicable database
system

14. Communicate
effectively to all departments

15. Completes
general administrative duties as assigned

16. Other
duties as assigned

Supervision

Requires moderate supervision

Minimum Qualifications

To perform this job successfully, an individual must be able
to perform each essential duty satisfactorily. The requirements listed below
are representative of the knowledge, skill, and/or ability required.

Possesses excellent communicative skills, both verbal and
written

Working knowledge of NCQA, JCAHO, and HIPPA regulations

Ability to read, analyze and interpret common journals

Maintains a high level of confidentiality and integrity in
dealing with sensitive issues, exhibiting professionalism at all times

Capability of building relationships with all levels of
providers, maintains working knowledge of current regulations

Ability to meet and adhere to stringent deadlines

Ability to assimilate and implement new information quickly
and effectively

Highly organized and able to work under stringent deadlines
with minimal supervision.

Extreme attention to detail with the ability to multi-task.

Education and/or Experience

High school diploma with 1 year credentialing experience
required, experience with credentialing for military installations preferred.

NCQA, JCAHO, and HIPPA regulations experience required.

High level of proficiency with Microsoft Outlook, Excel and
Word.

Competencies

  • To perform the job successfully, an individual
should demonstrate the following competencies:
Problem Solving

-
Identifies and resolves problems in a timely manner; Gathers and analyzes
information skillfully; Develops alternative solutions; Works well in group
problem solving situations; Uses reason even when dealing with emotional
topics.

Written Communication

  • Writes clearly and informatively; Edits work for spelling and grammar; Varies
writing style to meet needs; Presents numerical data effectively; Able to read
and interpret written information.

Diversity

-
Demonstrates knowledge of EEO policy; Shows respect and sensitivity for
cultural differences; Educates others on the value of diversity; Promotes a
harassment-free environment; Builds a diverse workforce.

Ethics

  • Treats
people with respect; Keeps commitments; Inspires the trust of others; Works
with integrity and ethically; Upholds organizational values.

Strategic Thinking

  • Develops strategies to achieve organizational goals; Understands
organization's strengths & weaknesses; Analyzes market and competition;
Identifies external threats and opportunities; Adapts strategy to changing
conditions.

Planning/Organizing

  • Prioritize and plans work activities; Uses time efficiently; Plans for
additional resources; Sets goals and objectives; Organizes or schedules other
people and their tasks; Develops realistic action plans.

Professionalism

-
Approaches others in a tactful manner; Reacts well under pressure; Treats
others with respect and consideration regardless of their status or position;
Accepts responsibility for own actions; Follows through on commitments.

Innovation

-
Displays original thinking and creativity; Meets challenges with
resourcefulness; Generates suggestions for improving work; Develops innovative
approaches and ideas; Presents ideas and information in a manner that gets
others' attention.

Qualifications -

To
perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are representative
of the knowledge, skill, and/or ability required. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential
functions.

Language Skills -

Ability to read, analyze, and interpret general
business periodicals, professional journals, technical procedures, or
governmental regulations. Ability to
write reports, proposals, business correspondence, and procedure manuals. Ability to effectively present information
and respond to questions from groups of managers, clients, customers, and the
general public.

Mathematical Skills -

Ability to apply concepts such as fractions,
percentages, ratios, and proportions to practical situations.

Reasoning Ability

  • Ability to define problems, collect data,
establish facts, and draw valid conclusions. Ability to question activities and
issues in all functional areas and make sound business decisions based on that
data.

Physical
Demands -

The physical demands described here are representative of those
that must be met by an employee to successfully perform the essential functions
of this job. Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.

While performing the duties of this Job, the employee is
regularly required to sit and talk or hear. The employee is frequently required
to walk; use hands to finger, handle, or feel and reach with hands and arms.
The employee is occasionally required to stand; climb or balance and stoop,
kneel, crouch, or crawl. The employee must occasionally lift and/or move up to
25 pounds. Specific vision abilities required by this job include close vision.

Work Environment -

The
work environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.

The employee will normally work in a temperature-controlled
office environment, with frequent exposure to electronic office equipment.

During visits to areas of operations, may be exposed to
extreme cold or hot weather conditions.
Is occasionally exposed to fumes or airborne particles, toxic or caustic
chemicals, and loud noise.

Chenega Corporation, is an EOE. AA/M/F/D/V. We participate
in the E-Verify Employment Verification Program.

Qualifications

Minimum Qualifications

To perform this job successfully, an individual must be able
to perform each essential duty satisfactorily. The requirements listed below
are representative of the knowledge, skill, and/or ability required.

Possesses excellent communicative skills, both verbal and
written

Working knowledge of NCQA, JCAHO, and HIPPA regulations

Ability to read, analyze and interpret common journals

Maintains a high level of confidentiality and integrity in
dealing with sensitive issues, exhibiting professionalism at all times

Capability of building relationships with all levels of
providers, maintains working knowledge of current regulations

Ability to meet and adhere to stringent deadlines

Ability to assimilate and implement new information quickly
and effectively

Highly organized and able to work under stringent deadlines
with minimal supervision.

Extreme attention to detail with the ability to multi-task.

Education and/or Experience

High school diploma with 1 year credentialing experience
required, experience with credentialing for military installations preferred.

NCQA, JCAHO, and HIPPA regulations experience required.

High level of proficiency with Microsoft Outlook, Excel and
Word.

Job

Human Resources

Primary Location

United States-Texas-San Antonio

Organization

Environmental and Healthcare Solutions SBU

Recruiter

Elisabeth Simpson

Chenega Corporation - 21 months ago - save job
About this company
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Chenega prides itself on providing industry leading market driven compensation, a comprehensive benefits program that is tuned to the market...