Med Staff Payor and Education Specialist - Full-Time (36 hours per week)
Regional Health Services of Howard County Cresco, IA
- Posted: over a month ago
POSITION SUMMARY: Coordinates with Provider Services & Recruitment to support, prepare, organize and disseminate credentialing information for RHSHC providing resources for the Medical Staff and Non-Physician Health Care Practitioners (NPHCP) for Credentialing. Coordinates all provider enrollment and insurance contracts, fulfilling duties and obligations as defined by regulatory agencies and RHSHC Medical Staff Bylaws Policies and Procedures. Assists with the assessment, development, implementation, orientation and evaluation of health care worker education and student programs for RHSHC. Displays a positive, pleasant, professional attitude to all customers. Exercises personal judgment and discretion in application of knowledge and policies governing work.
ESSENTIAL FUNCTIONS/DETAILED DUTIES:
- Coordinates application process for medical staff and allied health professional credentialing and maintains records for their professional licensure, registration, insurance, etc.
- Completes credentialing requests from various entities for all medical staff members and NPHCP's and the facility.
- Obtains and maintains the necessary provider numbers and NPI numbers for medical staff and/or the facility.
- Implements provider enrollment and reenrollment for the staff and facility.
- Collaborates with Vice Presidents, Directors, Charge Nurses and staff to assess learning needs and competencies. Identifies, develops, implements and evaluates curriculum, instructional materials and methods for new and ongoing programs based upon assessed needs.
- Maintains liaison with administration and departmental representatives in planning seminars, workshops, education programs and related activities. Participates in recruitment and selection of personnel to attend education programs.
- Coordinates BLS (CPR), ACLS, NRP, PALS and TNCC training for appropriate personnel. Makes records available to Departmental Directors.
- Assists with the collection of information and completion of the reappointment/recredentialing process for Physicians and Non-physician Health Care Providers at RHSHC.
- Assists with the process for collection of all expiring documents required in providers files and notify providers of the upcoming expiration of documents.
- Maintains an Excel database for inactive and archived providers Credentialing files.
- Coordinates the Order-Only Provider process including provider verifications, data entry and provider additions to the Doctor Database and Healthland System
- Managed Care Coordination with Provider Services & Recruitment
- Monthly OIG/SAM Compliance roster submission to HR.
- Functions as a Healthstream administrator
- Initiates the information collection, verification and documentation process to complete physician and NPHCP applications for RHSHC provider enrollment for health plans.
- Coordinates the review for initial and reappointment applications at RHSHC for the request and approval of RHSHC Medical Staff and NPHCP privileges.
- Prepares, maintains and provides initial applications and reappointment applications to Health plans for review and enrollment.
- Establishes and maintains medical staff database and other systems to assure confidentiality of activities related to credentialing/privileging, peer review, quality assessment, and provider enrollment in health plans and legal issues.
- Educates, Orients, and updates Medical Staff on the credentialing process and regulatory standards to help them consistently perform their functions.
- Onboarding and compliance review of submitted documents for Students job shadowing and/or Student practicums and Contracted staff.
- Annual reporting for the facility to include hospital licensure, AHA annual reporting, CRNA Reasonable Cost Payments reporting and MCO/ACO reporting including all regulatory, licensing's and certifications for the RHSHC providers and facility to ensure filing and renewal in a timely manner.
- Maintains required department confidentiality and abides by HIPPA regulations.
- Takes an active role in enhancing ability to carry out job functions through personal and professional /job related growth and development, and participates in medical center and/or department education programs.
- Performs other responsibilities as requested by CEO, CNO and Nurse Education Coordinator.
- Acts as back-up for the Executive Assistances in her/his absence.
- Excellent oral and written communication skills.
- Computer skills required.
- Minimum of high school education.
- Two years of hospital administrative assistance experience required with credentialing/recredentialing and provider enrollment experience required.
- Experience with credentialing/recredentialing and provider enrollment of Medical Staff, NPHCP and the organization required.
- Ability to work independently.
- Medical Staff Certification preferable, CPMSM or CPCS certification preferable.
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Regional Health Services of Howard County
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