JOB SUMMARY:

The Credentialing Specialist coordinates and completes hospital credentialing documentation (initial applications and reapplications) for all APII and/or PBM physicians; assisting in the maintenance of physician databases (OneApp and Access); maintains supporting documents for the physicians.

ESSENTIAL FUNCTIONS:

• Coordinate and complete all aspects of APII and/or PBM physician credentialing for all contracted facilities, including initial and reappointment applications, as directed by the management.
• Assist in process for on-boarding new physicians and for exiting physicians.
• Process upgrades, updates, edits, and deletions (programs) within the physician credentialing databases.
• Coordinate and maintain records (electronic and paper files) on all APII and/or PBM physicians.
• Compile QIP folders for each APII and/or PBM physician for review by management.
• Maintain list of completed CME courses for each APII and/or PBM physician.
• Assist with collecting, coding, and submission of physician expense reports to Accounts Payable. This includes tracking CME Fund totals.
• Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Become familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security Policies.
• Administer quarterly and ad hoc APII physician Quality Assurance reports from PathSys as requested by facilities.
• Coordinate the filing of AMA/PRA Certificate applications and reapplications for APII physicians.
• Administrator for QGenda for APII physician scheduling to track coverage and PTO.
• Assist with TMLT (Texas Medical Liability Trust) enrollment as needed for PBM physicians.
• Assist with CLIA preparation and inspections as assigned for PBM locations.
• Serve as primary point of contact for third party managed care and medical billing for PBM physicians.
• Sort and distribute department mail.
• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

EDUCATION & LICENSURE:

• High School Diploma or G.E.D. is required.
• Three to four years of prior job-related credentialing experience required.

SKILLS AND QUALIFICATIONS:

• Knowledge of medical terminology, physician credentialing/licensing, and previous database / document control system experience strongly preferred.
• Strong communication skills. Must be able to effectively communicate (oral and written) with all levels of personnel both within and outside of the company.
• Demonstrate ability to perform tasks with a high degree of accuracy and quality.
• Demonstrate ability to perform multiple tasks in a limited time frame.
• Ability to exercise independent judgment under minimal supervision; ability to function as a member of a team.
• Ability to comply with HIPAA regulations.
• Exhibit customer service focused skills.
• Must be able to assure confidentiality.
• Working knowledge of computer applications.
• Proficiency in use of MS Office products (Word, Excel, Outlook).