Credentialing and Administration Specialist

Job Description

Job Description

Description:

Shape Your Future. Serve Your Community. Build Your Career with Palms!

What Life Working at Palms Looks Like:

Mission and Meaningful Work: PMG is a not for profit, Federally Qualified Health Center (FQHC). That means it’s focused on serving underserved populations, offering affordable primary care and preventative services. For many people, that makes the work feel meaningful.

Stability & Growth: PMG has been around for a long time (since 1971) and we are still expanding!

Comprehensive Services & Variety: We offer a wide array of services – family medicine, pediatrics, dental, behavioral health, prenatal care, etc. – So working here gives exposure to different patient populations, conditions and settings.

Patient-Centered, Community Focus: PMG emphasizes accessible care (same day scheduling, weekend appointments, bilingual staff) and works in communities throughout North Florida. It is also a Patient Centered Medical Home (PCMH), meaning there’s an emphasis on continuity of care, relationships with patients, etc.

Culture & Community: Many reviews say that PMG has a “friendly, compassionate, professional” environment. There is pride among the staff in giving back to the community.

Perks:

Competitive Wages

Comprehensive Health Coverage: Medical, Dental and Vision Insurance

Professional Development Opportunities

Employee Assistance Programs

Company Paid Life Insurance

401k with 5% Match

11 Paid Holidays

20 Days PTO

Recognition and Rewards

Community Impact

Position Summary

The Credentialing and Administration Specialist performs a variety of complex clerical and is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Palms Medical Group.

Description of Primary Responsibilities

1. Shall credential newly hired providers with insurance companies and government insurance (including Medicaid and Medicare)
2. Shall complete initial internal credentialing/privileging process and Re-Credentialing/Re-Privileging as directed in the PMG Credentialing and Privileging Policy
3. Facilitate initial Privileging and Re-Privileging process per PMG Credentialing and Privileging Policy.
4. Credentials new facilities for the Medicaid and Medicare programs
5. Re-credentials all providers with insurance companies and government insurance as needed.
6. Organize and file all credentialing documentation and forms for both internal and insurance credentialing.
7. Maintain all location and provider binders.
8. Maintain all provider internal credentialing files.
9. Updates CAQH quarterly
10. Re-new pharmacy licenses, facility X-Ray licenses, and occupational business license
11. Updates and re-credentials lab licenses for all facilities.
12. Communicates with insurance companies regarding provider credentialing.
13. Assists providers as needed with credentialing questions.
14. Facilitate Credentialing Committee and Peer Review meeting schedules and notification with CMO.
15. Prepare meeting agenda and packet for Credentialing Committee meetings and Peer Review meetings.
16. Take minutes at committee meetings, and type minutes for Credentialing and Peer Review committee meetings to be included in meeting packets.
17. Facilitate Peer Review process for semiannual peer reviews for all providers.
18. Prepare aggregate reports according to Peer Review results for each provider.
19. Notify providers when re-privileging request is due, submit completed privileging request to Credentialing Committee, then to Board.
20. Prepare annual PMG Credentialing and Privileging Policy and PMG Peer Review Policy
21. Shall perform other related duties as requested by the VP of Financial Services, CFO or CEO.

Description of Primary Attributes

General Development:

1. Must be organized, a self-starter and detailed oriented
2. Job duties require the ability to work independently and as part of a team
3. Expected to coach, mentor and train clinical staff

Professional & Technical Knowledge:

1. 1 year of healthcare administration experience.
2. An AS degree or higher in healthcare information technology, healthcare administration or a degree in nursing is preferred but not required.
3. Education may be substituted for experience on a 1:1 basis.
4. Employee will be expected to navigate and operate Microsoft Office suite products, including Word and Excel

Licenses & Certifications:

1. High School Diploma or Equivalent
2. One (1) to three (3) years’ experience in a medical setting preferred with credentialing experience.
3. Current BLS (basic life support) Certification

Communications Skills:

1. Effectively and tactfully communicates complex and/or technical information to co-workers, patients and/or vendors

Physical/Mental/Emotional Demands:

• Standing for long periods of time
• Sitting for long periods of time
• Viewing a computer monitor for long periods of time
• Bending
• Stretching / Reaching
• Walking short distances
• Lifting up to 50 pounds
• Operating office equipment (computer, fax machines, telephones and copy machines)
• Reading forms / Instructions / Patients Charts
• Communicating well to people of various ages, educational levels, cultural backgrounds in person or by telephone
• Exposure to potentially violent / irate patients
• Health / Safety Consideration of Position
• Exposure to chemical infectious / contagious illness
• Exposure to chemical and inhalation of antibiotics during reconstitution
• Exposure to X-Ray radiation
• Exposure to a variety of scents and odors
• Must utilize universal precaution in clinical or exposure situations as prescribed by federal state, and local guidelines and /or laws