HomeJob SearchCredentialing Specialist
Franklin, Tennessee, USAPermanent positionFull time

Credentialing Specialist

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PURPOSE AND SCOPE:

Knowledgeable, experienced specialist responsible for initial verification for all existing and new providers to allow the practitionerto admit and treat patients atFMCNA locations. Collaborates with external credentialingagent to ensure credentialing processis completed. Ensures all provider credentialing verification is performed in accordance with regulatory and accreditation standards and FMCNA policy and procedure. Performs audits of 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. Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the Compliance Program, including following all regulatory and division/company policy requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Under limited supervision, applies considerable credentialing knowledge and skills to perform a wide range of moderately difficult tasks and assignments requiring judgment in resolving issues and/or in making recommendations. Normally receives no instruction on routine daily work, and general instructions on newly introduced assignments
  • Contacts are frequently with individuals representing other departments, and/or representing outside organizations.  Contacts involve obtaining or providing information or data on matters of moderate importance to the function of the department or which may be of a sensitive nature.
  • Perform provider credentialing verification tasks to facilitate compliance with Medical Staff by-laws regardingthe verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment. Responsiblefor tasks related to the three year cyclical verification process of all active practitioners.
  • Apply knowledge regarding national accreditation standards, internal medical staff bylaws and other related policies and regulations to perform functionspertaining to the provider credentialing process for the assigned division. This includes but is not limited to:

    • Obtaining practitionerlicense information from publicly available state/government agency websites, the National Provider Databank, and other 3rdparty certification groups such as the American Board of Internal Medicine.
    • Completing and processing all initial credential applications for new providers/practitionersand credential verification applications for existing providers 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 meets federal and state regulations as well as FMCNA internalrequirements.
    • Maintaining and updating the database on individual provider credentials' status, tracking pending/completed applications, and maintaining a complete and accurate database of historical applications. Provides regular reports and updates to pertinent field operations managementand Director of Operations Monitoring.
    • Communicating with providers regarding credentialing status, providing updates and obtaining additional information as required.
  • Educate and inform field staff responsible for reporting new providers regarding their responsibilities in the credential verification process. Explain the credentialing requirements, provider specific information, informationregarding the FMCNA third-party credential agent, regulations and industry standards for credentialing of health care providers and other information as applicable.
  • Continually audit and analyze the credentialingprocess to identify deficiencies in controls and to identify process/workflow issues recommending improvements to managerand implementing if approved.
  • Review internal Provider Databaseinformation and databaseof FMCNA provider informationcompiled by external credential verification agent to identify and take appropriate action where requiredto correct areas of noncompliance with company policy. This includes reporting to the appropriate stakeholders identified deficiencies in provider applications, providing information regarding providers non-compliant with verification policies, notifying the appropriate personnel regardingexpired board certifications, and other requirementsituation updates as applicable.
  • Generate various standard and ad hoc reports from database:

    • Prepare project status reports as required, detailing progress of credential verification status of individual practitioner credential applications for each division, and reporting variances and trends in the credentialing processas identified to the Director of OperationsMonitoring.
    • Prepare reports detailing credential verification issues to pertinent field staff and credentialverification agent.
    • The monthly provider credentialing status report for review by the Director of 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.
  • May escalate issues to supervisor for resolution, as deemed necessary.
  • 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.

    • Day to day work includes desk and personal computer work and interaction with internaland external customers.

EDUCATION:

  • High School Diploma required; Associates Degree in Business, HealthCare Administration, or other related field desirable.

EXPERIENCE AND REQUIRED SKILLS:

  • Minimum 2 - 4 years' experience in credential verification or in a Physician practice/Medical office or other similar experiencein a healthcare setting; or Associates Degree in Business,HealthCare Administration, or other related field with 1 - 2 years' 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 internaland external contacts.
  • Perform work at a high level of accuracy and timelines.
  • Attention to confidentialityand regard for protecting confidential and sensitiveinformation.
  • 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.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

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

Career with a purpose

Career with a purpose

We offer an opportunity to create and deliver treatments that save and change lives for the better. We’ll support your ongoing development. And you’ll be part of a dedicated team of people who inspire each other to create the best possible healthcare outcomes each and every day.
Inclusion and diversity

Inclusion and diversity

Joining Fresenius Medical Care means becoming part of a team that values diversity. We embrace the wealth of different backgrounds, cultures, experiences and opinions that make up our workforce and strive to create an inclusive atmosphere in which all our employees feel valued.
Stability

Stability

Developing innovative products and continuously improving our renal therapies made us the clear market leader in the production of hemodialysis machines, with sustainable, profitable growth . This position provides our 125000 employees with the stability and security they need to help improve the lives of our patients.
Learning and development

Learning and development

We offer participation in programs at world-class business schools, leadership development, regular training for our nurses, health care professionals and manufacturing staff and digital access to high-quality educational content for all employees worldwide 24/7. 
Local benefits

Local benefits

Our employees enjoy both local and global opportunities for growth and personal fulfilment. We offer local benefits designed to suit the requirements of the respective country and place of work to create ideal conditions everywhere.
Work-life balance

Work-life balance

We want to empower people to deliver better care. Therefore, we promote a better work-life balance through flexible working hours, part-time models, the possibility to work from home, and more.
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At a glance

Earliest possible start:

As from now

Contract type:

Permanent position

Company:

Fresenius Medical Care

Region / Business Unit:

North America

Location:

Franklin (Tennessee, USA)

Working condition:

Full time

Job Function:

Legal & Compliance

Reference number:

R0175971

Publishing date:

10/09/2024

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Collaborative

We care about sharing information and experiences as this helps us learn from our mistakes and each other. We tackle challenges together by reaching out to colleagues both near and far. We communicate openly.

Proactive

We challenge the status quo and show interest in what happens around us. We ask questions to clearly understand what needs to be done and take ownership of the results.

Reliable

We live up to our own expectations, show respect and lead by example. We act with integrity and in line with our standards every day.

Excellent

We make things better today than they were yesterday. We pitch ideas on how to improve and innovate.

What we stand for

Empowering people. Advancing care. Inspiring with our purpose and values.

Everything we do here is about making people’s lives better, simpler and longer. Our teams work cross-functionally to reproduce the complex function of kidneys with treatments that meet high quality standards, improve clinical outcomes, and are sustainable and compliant. Internally, we promote diversity and inclusion as key elements of a positive, supportive work environment. Our values support our mission to develop high quality products and services, to have a positive impact on the health and wellbeing of patients, and to lead Fresenius Medical Care towards a successful, sustainable future.