Credentialing Specialist at Fresenius Medical Care North America Chandler, AZ

Credentialing Specialist job at Fresenius Medical Care North America located in Chandler, AZ. Purpose and Scope FMCNA locations collaborate with a third‑party credentialing agent to ensure the credentialing process is completed as required. The role ensures all provider credentialing verifications are performed in accordance with regulatory and accreditation standards as well as internal FMCNA policy and procedure. Responsibilities include performing audits of both the internal FMCNA Provider Database and the external credential verification agent’s data to confirm timely completion of credential verification in line with all regulatory and company requirements. Principal Duties and Responsibilities Under close supervision, utilize established procedures to perform routine assigned tasks. Learn professional concepts and apply company policies and procedures to resolve routine issues. Work on problems of limited scope, following standard practices and procedures to analyze situations or data from which answers can be readily obtained. Escalate issues to supervisor for resolution as deemed necessary. Perform provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff by‑laws regarding the minimum set of a practitioner’s credentials required prior to the second treatment of a patient. Responsible for tasks related to the three‑year cyclical verification process of all active practitioners. Utilize knowledge of 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, including but not limited to: Obtaining practitioner license information from publicly available state or government agency websites, the National Provider Databank, and other third‑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 history of applications. Providing regular reports and updates to pertinent FMS field operations management and the Director of Operations Monitoring. Communicating with practitioners regarding credentialing status, providing updates, and obtaining additional information as required. Educating and informing FMS field staff responsible for reporting new practitioners about their responsibilities in the credential verification process, explaining credentialing requirements, practitioner‑specific information, information regarding the FMCNA third‑party credential agent, regulations, and industry standards for credentialing of health care providers, and other applicable information. Continuously auditing and analyzing the credentialing process to identify deficiencies in controls and workflow, recommending improvements to the manager, and implementing approved changes. Reviewing the internal Provider Database information and the database of FMCNA provider information compiled by the external credential verification agent to identify and take appropriate action where required to correct areas of noncompliance with company policy, including reporting deficiencies in provider applications, reporting providers non‑compliant with verification policies, expired board certifications, and other requirements. Generating various standard and ad‑hoc reports from the database, such as project status reports detailing the progress of credential verification status of individual practitioner credential applications for each FMS Division, and reporting variances and trends in the credentialing process to the Director of Operations Monitoring. Preparing reports detailing credential verification issues to pertinent field staff and the credential verification agent, including the monthly provider/practitioner credentialing status report for review by the Director of Operations Monitoring. Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state, and federal laws and regulations. Assist with various projects assigned by the direct supervisor. Other duties as assigned. Physical Demands and Working Conditions The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Bachelor’s Degree required. Experience and Required Skills 0–2 years of related experience. Strong detail orientation with the ability to administer multiple tasks and prioritize. Excellent verbal and written communication skills. Ability to positively interact with providers, hospital personnel, and other internal and external contacts. High level of accuracy and adherence to timelines in work performance. Attention to confidentiality and the protection of confidential and sensitive information. Advanced level skills with Microsoft Access, Excel, and Word. Strong problem‑solving and time‑management skills, consistently working in a fast‑paced environment. Strong Excel, database management, and document storage and management skills. Fresenius Medical Care maintains a drug‑free workplace in accordance with applicable federal and state laws. EOE, disability/veterans #J-18808-Ljbffr