Minnesota Urology P.A.
  • 06-Jan-2019 to 07-Mar-2019 (EST)
  • Bloomington, MN, USA
  • Hourly
  • Full Time
  • Minnesota Urology

Medical, Dental, Basic Life, Short Term/Long Term Disability, HSA, Dependent Care, Flexible Spending, 401K, PTO and Holiday Pay


JOB TITLE:    Credentialing Specialist 

AREA OF RESPONSIBILITY: Business Services Department/Business Office 

SUPERVISION RECEIVED: Reports to Business Office Manager 

SUPERVISION EXERCISED: None

 

SUMMARY: The Credentialing Specialist is responsible for activities involving all aspects in the coordination of credentialing process including new provider credentialing and re-credentialing of existing physicians and advanced practice providers.  Primary responsibility is to ensure accuracy and completeness of all documentation that providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities.  Maintain knowledge of current credentialing related regulations, industry standards and best practices.

This is a full-time position that is based out of our Bloomington, MN location.

JOB DESCRIPTION:

  1. Coordinates all hospital, payer, and care facilities credentialing/re-credentialing for all Physicians and advanced practice providers. 
  2. Utilizes credentialing software and other computer applications to maintain current and accurate electronic credentialing records, and documentation of professional qualifications for all company providers. 
  3. Corresponding with providers and/or credentialing contacts regarding the need for additional information and/or the status/outcome of the credentialing process. 
  4. Assists in the Fellowship Program verifies credentials and handles the credentialing process. 
  5. Track RN, LPN and any other licensures that are required for Minnesota Urology's staff members including provider DEA and professional liability expirations.  
  6. Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation, and understands the direct impact on the practices revenue cycle.  
  7. Reviews and screens initial provider credentialing applications for completeness, accuracy, and compliance with federal, state, and local regulations, guidelines, policies, and standards.  
  8. Ensure policies and procedures are up to date with current credentialing related regulations, industry standards and best practices.  
  9. Interprets federal, state, local and government and insurance agency regulations and guidelines, and advises providers and management on compliance issues as appropriate. Works towards compliance in every aspect of the position.  
  10. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external agencies as appropriate. Perform audits of verified credentialing files upon completion. 
  11. Maintains confidential files on all provider credentials, and other pertinent information to ensure accurate up to date records. 
  12. Ensures practice addresses are current with health plans, agencies and other entities.  
  13. Attends various meetings and enhances professional development and growth on a regular basis; make recommendations for revision and/or new departmental procedures under the direction of the manager.      
  14. Responsible for being up-to-date and knowledgeable of basic insurance information. 
  15. Reports on the status of processing applications to the appropriate persons. Responds to emails and other correspondence with information requested and/or updates in a timely manner.  
  16. Maintains internal provider grid to ensure all information is accurate and up to date.  
  17. Completes any/all assigned business office tasks in an accurate and timely manner. 
  18. Regular attendance is required.
  19. Other duties as assigned.

 

ESSENTIAL JOB FUNCTIONS: 

  1. Ideal candidate must be highly self-motivated with a proven expertise in the healthcare physician credentialing, re-credentialing, and provider enrollment.
  2. Proficient with credentialing systems
  3. Management of multiple duties, basic computers skills, and interaction with physicians, administration, and patients.
  4. Knowledge of basic insurance policies, procedures and reimbursement practices.
  5. Represent Minnesota Urology in a professional manner related to appearance, communication, and the maintenance of patient and company confidentiality.
  6. Ability to effectively communicate and work efficiently with manager, administration, physicians, patients, and staff.
  7. Ability to analyze work methods to effectively organize work, make improvements, and correct problems.
  8. Supportive of the goals and objectives of Minnesota Urology.
  9. Think and work effectively under pressure and accurately complete tasks within the established guidelines. Prioritize and meet deadlines.
  10. Ability to communicate effectively, both orally and in writing.
  11. Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
  12. Must be able to read, write, speak and understand English.

 

EDUCATION/TRAINING/LICENSURE: 

  1. Preferred - Completion of Associates degree and 2-5 years related experience.  Additional experience may be substitutive for degree.
  2. Required Certified Provider Credentialing Specialist (CPCS).

 

EQUIPMENT USED TO PERFORM ESSENTIAL JOB FUNCTIONS: Computer, keyboard and monitor, calculator, writing utensils, fax machine, scanner, copy machine, telephone. 

TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time working in an office environment. Some bending and stretching required.  Ability to lift five to ten pounds including cases of boxed office supplies, etc.  Working in a fast paced environment and use of PC and telephone are required.  Manual dexterity required for use of all office equipment.  May require travel to various locations. 

TYPICAL WORKING CONDITIONS: Normal office environment. Contact with physicians, staff and various representative from hospitals, and clinics.

 

Minnesota Urology P.A. is an equal opportunity employer.

Minnesota Urology P.A.
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