Credentialing & Privileging Specialist

Overview

Supports the mission of People's Community Clinic by coordinating all aspects of the credentialing and/or re-credentialing process, as well as changes in privileges/specialty or demographic information for health care professionals practicing with People’s Community Clinic health centers. This position ensures health care professionals are appropriately credentialed and have privileges, including ongoing maintenance and verification of current information on file and within the credentialing database, and other duties required to maintain compliance with regulatory agencies and People’s Community Clinic policies and procedures.

Location: 1101 Camino La Costa, Austin, Texas, 78752

Compensation: $21.00- $26.00 per hour based on experience and qualifications

Responsibilities

Under the supervision of the Clinical Quality & Risk Management Director, this individual’s primary responsibilities include:

Internal Credentialing & Privileging:

• Reviews, screens, and completes initial credentialing and/or re-credentialing, and additional privilege request applications for completeness, accuracy, and compliance with federal, state, local, and People’s Community Clinic policies and procedures.
• Perform and collect primary source verifications (PSV) of all credentialing elements and validate the information for accuracy.
• Maintain credentialing and privileging files for all licensed and certified staff in compliance with Federal Tort Claims Act (FTCA) requirements.
• Maintain and enter new applications in the credentialing database.
• Work with the Chief Medical Officer to process applications for appointment and reappointment of privileges.
• Track expirations and maintain current copies of licenses, certifications, DEA, board certifications, CPR training, and professional liability.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Report issues in a timely manner to the Clinical Quality & Risk Management Director and the Chief Medical Officer, as necessary, for decision-making in accordance with credentialing and privileging policies.
• Conduct required National Databank and OIG searches for new and current providers and coordinate with human resources for completion of required criminal background checks.
• Identify opportunities to improve workflow, work processes, and patient care, and work cooperatively to implement those improvements.
• Assist with the development and revision of relevant policies and procedures.

Other Job Responsibilities:

• Responsible for the monthly ongoing monitoring of licenses and sanctions.
• Respond to emails timely and effectively.
• Provide support to physicians, physician office staff, and company departments as necessary.

• Responsible for ensuring practitioners’ credentials are sent to the third-party payor enrollment contractor.
• Prepare and maintain credentialing files and reports for all individual providers, including maintenance of credentialing software, provider rosters, and spreadsheets to comply with group delegation requirements, as required.
• Answer questions, process requests from staff/providers related to credentialing information, and provide support as needed in all aspects of the credentialing process. 

HIPAA:

• Adhere to HIPAA guidelines.

Qualifications

Education: 

• High School Diploma/GED
• Bachelor’s or associate degree from an accredited college/university with a major in a related field may substitute for two years of the required experience.

Experience:

• Two years of relevant credentialing experience; FQHC experience is a plus.

Knowledge, Skills, and Abilities:

• Knowledge and understanding of the credentialing process.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills, including letters, memos, and emails.
• Excellent attention to detail.
• Strong organizational, problem-solving, and critical thinking skills, and proactively prioritizes needs and effectively manages resources.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
• Ability to function effectively in a remote work environment.

Certification/Licensure :

• Certified Provider Credentialing Specialist (CPCS) within the first 3 years of employment if not already certified upon hire.

Our Benefits Include:

• 18 PTO days per year & 11 paid holidays
• Major Medical Health Insurance Coverage. Most employees experience $0 in out-of-pocket medical expenses.
• Dental & Vision
• Flexible Spending Accounts
• Employer-paid Life Insurance
• Employer-paid Short-Term and Long-Term Disability
• Annual Training
• 403(b) with 5% employer matching

People’s Community Clinic is committed to equal employment opportunity regardless of race, color, national origin, religion, gender, sexual orientation, age, language, disability, pregnancy, gender identity or sex stereotyping.