Provider Credentialing Spec Job in Waltham 02451, Massachusetts US
A career connection worth making
Meaningful connections. For someone with a renal condition, the smallest level of support and dependability can mean the world. That’s why Fresenius Medical Care North America is constantly looking for talented individuals who are focused on one thing: helping people live better lives. By joining a leading provider of renal care products and services, you’ll enjoy incredible growth and stability, but you’ll also play an important role in providing the consistent care that can make a real difference in our patients’ treatments. Now that’s a connection worth making.
Provider Credentialing Spec
PURPOSE AND SCOPE:
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and division/company policy requirements.
Responsible for performing the initial verification for all existing and new providers to allow the practitioner to admit and treat patients at FMCNA locations. Coolaborates with a third party/external credentialing agent to ensure credentioaling process is complete as required. Ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards as well as internal FMCNA policy and procedures. 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.
DUTIES / ACTIVITIES:
CUSTOMER SERVICE:
- Responsible for driving the FMCNA culture through values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
- Performs provider credentialing verification tasks to facilitate compliance with Medical Staff by-laws regarding the verification of a minimum set of practitioner's credentials required prior to the patient receiving their second treatment. Responsible for tasks related to the three year cycle verification process of all active practitioners.
- Utilizes knowledge regarding national accreditation standards, internal medical staff by-laws and other related policies and regulations to perform functions pertaining to the provider 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 in a timely and accurate manner.
- Conducting follow up as needed, acting as the primary liaison for FMCNA locations, practitioners, and the FMCNA 3rd party credentialing agent to ensure that all credentialing is completed within the required timelines and that each provider meets federal and state regulations as well as FMCNA internal requirements.
- Maintaining and updating database on individual provider 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 Operations Monitoring.
- Communicating with providers regarding credentialing status, providing updates and obtaining additional information as required.
- Educates and informs FMS field staff responsible for reporting new providers regarding their responsibilities in the credential verification process. Explains the credentialing requirements, provider specific information, information regarding the FMCNA 3rd party credentialing agent, regulations and industry standards for credentialing of health care providers and other information as applicable.
- Continually audits and analyzes the credentialing process to identify deficiencies in controls and to identify process/workflow issues recommending improvements to manager and implementing if applicable.
- Reviews internal provider database information and database of FMCNA provider information compiled by external credential verification agent to identify and takes appropriate action where required to correct areas of non-compliance with company policy. This includes reporting to the appropriate stakeholders identified deficiencies in provider applications, providing information regarding providers non-compliant with verification policies, notifying the appropriate personnel regarding expired board certifications, and other requirement situation updates as applicable.
- Responsible for generating various standard and ad hoc reports form database:
- Prepares project status reports as required, detailing progress of credential verification status of individual practitioner credential applications to each FMS Division, and reporting variances and trends in the credentialing process as identified to the Director Operations Monitoring.
- Prepares reports detailing credential verification issues to pertinent field staff and credential verification agent.
- The monthly provider credentialing status report for review by Director Operations Monitoring.
- Other duties as assigned.
PHYSICAL DEMANDS AND WORK CONDITIONS:
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.
Day to day work includes desk and personal computer work and interaction with internal and external customers.
EDUCATION:
- Associates Degree in Business, Health Care Administration, or other related field. Or at least, 4 years work experience as described below. required.
EXPERIENCE AND REQUIRED SKILLS:
- Minimum 3 year experience in credentialing verification or in a Physician practice/Medical office or other similar experience in a healthcare setting.
- Strong detail orientation required, with the ability to administer multiple tasks and prioritize.
- Excellent verbal and written communications skills.
- Ability to positively interact with Providers, hospitals personnel, and other internal and external contacts.
- Perform work at a high level of accuracy and timeliness.
- Attention to confidentiality and regard for protecting confidential and sensitive information.
- Advanced level skills with Microsoft Access, Excel and Word.
- Strong problem solving and time management skills with the ability to consistently work in a fast paced environment.
- Strong Excel, data-base management, and document storage and management skills.
