Credentialing Specialist

Location

Green Bay, WI | United States

Job description

SALARY : $20.73/Hr.
(Employees will receive 5% below the negotiated pay rate during their probationary status)
Non-Exempt

POSITION SUMMARY
Plan, develop and assist in the coordination and implementation of contracting and credentialing strategies to enhance revenue and Oneida Nation’s Workforce. This position will be credentialing and contracting for all healthcare staff. Ensuring requirements from federal, state, accrediting agencies are being met for all related Medical Staff functions. Continuation of this position is contingent upon funding allocations.

1. Provide administrative support to Health Center departments and credentialing applicants as needed.
2. Answer incoming telephone calls, determines purpose of call, and forward to appropriate personnel or department, ensuring professional telephone etiquette. Screen incoming calls and correspondence; exercises judgment and responds accordingly. Receives, sorts, logs, and routes mail.
3. Meet with applicants to ensure thorough completion of required documents.
4. Scrutinizing provider applications and resumes for completion, consistency, and accuracy. This includes quickly identifying any discrepancies, gaps of employment and other challenges that could negatively impact our ability to credential a provider.
5. Welcome visitors and determine nature of business, and announces visitor to appropriate personnel, maintaining professional and courteous demeanor.
6. Verifies, researches, and responds to telephone and written inquiries from Clinicians, insurers, payers, partnership groups and team members, pertaining to provider participation and credentialing status.
7. Works with internal Billing team members to ensure list of all current payers is maintained.
8. Participate in appropriate meetings and committees relative to the position’s responsibilities.
9. Oversee and track all license, DEA, malpractice insurance, Continuing Medical Education (CME) and any other expiable document to make sure they are current in the credentialing database for all healthcare staff.
10. Assists with the onboarding process of healthcare provider staff throughout the Comprehensive Health Division.
11. Administer credentialing and re-credentialing process for Oneida Nation, all payers, insurance companies and networks as needed.
12. Obtain verifications, references, and other pertinent data from appropriate sources in a timely manner.
13. Work closely with Oneida Community Health Division (OCHD) clinicians, internal team members, and any third-party groups to follow up on outstanding items needed to complete files in a timely manner.
14. Administer the credentialing software.
15. Processes contracts with payers, insurance carriers and networks.
16. Provides verification of provider information for credentialing, re-credentialing and continued access to payers, insurance carriers and networks computer systems.
17. Continued effort to update provider directories for the various payers, insurance companies and networks.
18. Adhere to all Tribal Personnel Policies and Procedures, Tribal Standard Operating Procedures, and Area and Program Strategic Plans and Policies.
19. The above duties and responsibilities are not an all-inclusive list but rather a general representation of the duties and responsibilities associated with this position. The duties and responsibilities will be subject to change based on organizational needs and/or deemed necessary by the supervisor.

1. Frequently walk, sit; occasionally stand, lift and/or move up to twenty-five (25) pounds.
2. Work is performed in an office setting with a moderate noise level.
3. Must be able to work a flexible work schedule to include evenings and weekends.
4. A Tuberculosis (TB) Screening and/or TB Skin Test is required within thirty (30) days of employment and annually thereafter as required.

1. Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment.
2. Skill in facilitating small groups in a training setting.
3. Ability to research and develop instructional and training materials.
4. Ability to work as a team member and foster a positive working environment.
5. Ability to set and meet priorities, meet strict deadlines and the ability to successfully cope with challenging situations and conditions.
6. Proficient knowledge of medical terminology and regulatory agency.
7. Strong interpersonal and communication skills.
8. Must present a professional appearance and demeanor as a representative of the Oneida Nation in dealing with the public.
9. Ability to work independently.
10. Ability to inform and communicate verbally and in writing in diverse and challenging situations with the ability to process information effectively, identify and define problems and make objective decisions.
11. Ability to establish and maintain good working relationships with the individuals of varying social and cultural backgrounds.
12. Knowledge of various computer systems/software or the willingness to learn systems such as, Microsoft Office, Modio, OneView, and other systems as needed.
13. Maintain strict departmental security, confidentiality, and quality to meet professional standards of the department.
14. Must complete Health Insurance Portability and Accountability Act (HIPAA) training within thirty (30) days of employment and annually thereafter.
15. Must be willing and able to obtain additional education and training.
16. Must comply with Caregiver Law and Grant conditions criminal history checks as a condition of employment to include fingerprinting .
17. Employees are required to have proof of immunity or dates of two (2) doses of MMR and proof of immunity or dates of two (2) doses of Varicella prior to starting in any position within the Oneida Comprehensive Health Division. Any refusal of vaccination(s) or failure to provide proof of immunity may disqualify the applicant.
18. Must pass a pre-employment drug screening. Must adhere to the Tribe’s Drug and Alcohol-Free Workplace Policy during employment.
19. Must pass a background security check with the Oneida Nation to meet the Employment Eligibility Requirements, Tribal/State Compact and/or Oneida Nation Gaming Ordinance as they pertain to the position. A temporary license or Gaming License issued by the Oneida Gaming Commission is required as a condition of employment and continuing employment within the Oneida Nation’s Gaming Division.
20. A valid, non-probationary driver’s license or occupational driver’s license, reliable transportation, and insurance are required. Must obtain a Wisconsin non-probationary driver’s license or occupational driver’s license within thirty (30) days of employment if applicant has an out-of-state driver’s license. Must be authorized as eligible to operate a personal vehicle under the Oneida Nation’s Vehicle Driver Certification and Fleet Management Policy prior to actual start date. Must maintain driver’s eligibility as a condition of employment.

1. Knowledge of Oneida Nation’s personnel policies and procedures.
2. Experience in developing and facilitating presentations.
3. Certification through one of the following National Association Medical Staff Services (NAMSS) , Certification for Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or certification obtained within 60 days of employment.

1. Minimum of three (3) years of experience in a health care environment.
2. Two (2) years of provider, payer, insurance company and network contracting/credentialing experience at a healthcare care facility, hospital system or managed care organization, or
3. Two (2) year experience in a healthcare role that directly interacts with providers.

1. Must provide a copy of diploma, license, degree, or certification upon employment.
2. Must have received or be willing to receive the COVID-19 vaccination by date of hire to be considered. Proof of vaccination required.
3. Background information disclosure (BID) form.

Job tags

Salary