Credentialing Specialist

PURPOSE AND SCOPE:

FMCNA locations. Collaborates with a third party/external credentialing agent to ensure credentialing process is completed as required.

Ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards as well as internal

FMCNA policy and procedure. Performs audits of both the internal FMCNA Provider Database and FMCNA provider information

compiled by the external credential verification agent to ensure that credential verification is completed in a timely manner according to

all regulatory and company requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Under close supervision, utilizes established procedures to perform routine assigned tasks¦
• Learns to use professional concepts. Applies company policies and procedures to resolve routine issues.
• Works on problems of limited scope. Follows standard practices and procedures in analyzing situations or data from which answers can be readily obtained.
• May escalate issues to supervisor for resolution, as deemed necessary.
•  Performs provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff by-laws regarding the verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment.
• Responsible for tasks related to the three-year cyclical verification process of all active practitioners.
• Utilizes knowledge regarding 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. This includes but is not limited to:
  • Obtaining practitioner license information from publicly available state/government agency websites, the National Provider Databank, and other 3rd 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 database of historical applications. Provides regular reports and updates to pertinent FMS field operations management and Director Operation Monitoring.
  • Communicating with practitioners regarding credentialing status, providing updates and obtaining additional information as required.
• Educates and informs FMS field staff responsible for reporting new practitioners regarding their responsibilities in the credential verification process. Explains the 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 information as applicable
• Continually audits and analyzes the credentialing process to identify deficiencies in controls and to identify process/workflow issues recommending improvements to manager and implementing if approved.
• Review internal Provider Database information and database of FMCNA provider information compiled by external credential verification agent to identify and take appropriate action where required to correct areas of noncompliance with company policy, such as reporting requirements of identified deficiencies in provider applications, reporting of providers non-compliant with verification policies, expired board certifications and other requirements as applicable.

• Responsible for generating various standard and ad hoc reports from database:

  •  Prepares project status reports as required, detailing progress of credential verification status of individual practitioner credential applications for each FMS Division, and reporting variances and trends in the credentialin process as identified to the Director Operations Monitoring.
  • Prepares reports detailing credential verification issues to pertinent field staff and credential verification agent
  • The monthly provider/practitioner credentialing status report for review by Director 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 as assigned by direct supervisor
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.

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' related experience.
• Strong detail orientation required, 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.
• Perform work at a high level of accuracy and timelines.
• Attention to confidentiality and regard for protecting confidential and sensitive information
• Advanced level skills with Microsoft Access, Excel, and Word.
• Strong problem solving and time management skills with the ability to consistently work in a fast-paced environment.
• Strong Excel, data-base management, and document storage and management skills

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.