HIM Credentialing Specialist

Location 1305 OLD US HWY 6, Cambridge, NE, 69022, United States Job Category Health Information Management Employee Type Full Time Essential Functions Attention to Detail — Job requires being careful about detail and thorough in completing work tasks. Assists with the processing of credentialing applications and appointment/reappointment processes. Assures all applications are processed completely and in a timely manner. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with medical staff Bylaws, medical staff Rules and Regulations, and accrediting organization standards. Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners. Conveys any problems or concerns to the Health Information Management Director for further review. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies. Prepares, issues, tracks, and follows-up on appropriate verifications for efficient processing of individual applications. Prepares forms, reports and provider scorecards as required. Knowledge of medical staff bylaws, medical staff rules and regulations, as well as accrediting organization standards, Center for Medicare and Medicaid Services (CMS) regulations, state regulations and other regulatory agencies as they pertain to medical staff and allied health professionals. Works with a Credentials Verification Organization (CVO) to collect, validate and assess completeness of all information and qualifications relative to credentialing standards of Tri Valley Health System. Communicates clearly with providers, their liaisons, the Medical Staff, leadership, and administration as needed regarding credentialing and privileging issues as they arise. Prepares and provides information to internal and external customers as appropriate. Communicates regularly with the Health Information Management Director regarding any problems, issues or concerns in his/her sections. Deals with a wide variety of personalities in a professional and tactful manner. Collaborates and coordinates with medical staff leaders and administrative representatives. Assists in answering the telephones and taking accurate messages. Maintains a good working relationship within the department and other departments. Regular and Reliable Attendance. Coordinates and completes all medical appointment and reappointment processes in a timely manner to ensure compliance. Protects the confidentiality of all records, as well as access to computer files and access codes. Supports and maintains a culture of safety and quality. Ability to prioritize activities day-to-day, guiding oneself with little supervision and depending on oneself to get things done. Stays current in field through continuing education, professional societies and journals. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry. Perform miscellaneous job-related duties as assigned. Promotes and adheres to the provisions of the compliance program. Communicates the mission, ethics and goals of the facility. Complies with all organizational policies regarding ethical business practices. Promotes and adheres to the TVHS core values and Standards of Behavior. Requirements High School Diploma required 1-2 years similar work experience preferred Strong computer skills and proficiency in Excel, MS Word and Outlook required Summary Non-Exempt, FT Position (This is not a remote position). General Summary Evaluates, analyzes and coordinates all aspects of the credentialing and recredentialing application process for all members of the Medical Staff of Tri Valley Health System. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Assists with certification tracking of all clinical staff and payer credentialing activities. #J-18808-Ljbffr HorseShoe Beverage Company