Credentialing Specialist

PURPOSE AND SCOPE:

FMCNA locations.

Collaborates with a third party/external credentialing agent to ensure credentialing process is completed as required.

Ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards as well as internal

FMCNA policy and procedure.

Performs audits of both the internal FMCNA Provider Database and FMCNA provider information

compiled by the external credential verification agent to ensure that credential verification is completed in a timely manner according to

all regulatory and company requirements.

  

PRINCIPAL DUTIES AND RESPONSIBILITIES:


* Under close supervision, utilizes established procedures to perform routine assigned tasks¦


* Learns to use professional concepts.

Applies company policies and procedures to resolve routine issues.


* Works on problems of limited scope.

Follows standard practices and procedures in analyzing situations or data from which answers can be readily obtained.


* May escalate issues to supervisor for resolution, as deemed necessary.


*  Performs provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff by-laws regarding the verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment.


* Responsible for tasks related to the three-year cyclical verification process of all active practitioners.


* Utilizes knowledge regarding national accreditation standards, internal medical staff bylaws and other related policies and regulations to perform functions pertaining to the provider/practitioner credentialing process for the FMS Division.

This includes but is not limited to:
+ Obtaining practitioner license information from publicly available state/government agency websites, the National Provider Databank, and other 3rd party certification groups such as the American Board of Internal Medicine
+ Completing and processing all initial credential applications for new providers/practitioners and credential verification applications for existing providers/practitioners in a timely and accurate manner
+ Conducting follow up as needed, acting as the primary liaison for FMCNA locations, practitioners, and the FMCNA third- party credentialing agent to ensure that all credentialing is completed within the required timelines and that each provider/practitioner meets federal and state regulations as well as FMCNA internal requirements
+ Maintaining and updating the database on individual provider/practitioner credentials' status, tracking pending/completed applications, and maintaining a complete and accurate database of historical applications.

Provides regular reports and updates to pertinent FMS field operations management and Director Operation Monitoring.
+ Communicating with practitioners regarding credentialing status, providing updates and ...