Credentialing Specialist

MEDICAL CREDENTIALING SPECIALIST

SITE OF SERVICE:

·       William Beaumont Army Medical Center (WBAMC), Fort Bliss, TX

·       Full Time

POSITION QUALIFICATION/REQUIREMENTS:

·       Education: Possess a high school diploma or equivalent GED certificate plus a minimum of one year at university or junior/community college. 

·       Cardiac Certifications: Must have the following hands-on certification through the American Heart Association or American Red Cross: Basic Life Support (BLS).

·       Experience: Possess a minimum of two years of experience within the last four years working in a hospital, insurance network, or managed care environment where at least 50% of the time was spent focused on verifying and maintaining the credentials of licensed, registered, and/or certified medical personnel, including but not limited to physicians, advanced practice registered nurses, physician assistants, therapists, etc.

·       U.S. Citizenship: Shall be a U.S. citizen

·       English Language Requirement: Shall be able to read, write, speak and understand English well enough to effectively communicate with all patients and other health care providers.

·       Physical Capability: Shall be physically capable of standing and/or sitting for extended periods of time and physically capable of performing all services required under the contract.

DUTIES:

·       Coordinate and communicate activities with the WBAMC Credentialing Office supervisor.

·       Perform primary and secondary source verifications of credentials according to departmental policy.

·       Establish and update practitioner’s credentials files (PCF) and provider activity files (PAF) on providers going through the process. Audit files for completed information upon submission, request missing data from providers. Ensure accuracy and completeness of files via application of appropriate regulations. Ensure that designated HCPs receive and maintain a valid, current license. Maintain liaison with educational institutions, state licensing agencies, hospitals, professional associations, specialty boards, and governmental staff offices. Ensure provision of clear, written delineation of clinical privileges to each HCP.

·       Notify Network Services Representatives when unable to obtain required documentation.

·       Prepare files for presentation to the Chief Medical Officer and Credentialing Committee.

HOURS:

·       Monday through Friday. 0730 to 1600 or 1630 but can vary as dictated by the mission to medically screen all personnel scheduled to be processed on that day or as directed by the medical facility.

·       Shifts will normally be scheduled for an 8.5 hour to 9-hour period, to include an uncompensated 30-to-60-minute lunch break, respectively.

·       In no instance will HCW be required to provide services of more than 80 hours per two-week period.

Base Down Days:

During a planned closure of the facility due to training, closures before or after holidays family down days, Employee will only be compensated for the actual hours worked. If clinic is closed and employee is not able to work, employee will be required to use leave or take LWOP (without penalty). 

SPECIAL REQUIREMENTS/SKILLS

Must be comfortable in a fast-paced, dynamic environment. Must be able and willing to reprioritize on short notice and work on multiple simultaneous projects. Flexible and able to work with various personalities. Teamwork skills required. Time management skills required. The ability to meet deadlines in a deadline intensive environment is essential. High level of adaptability and willingness to embrace change in a fast-paced, demanding environment.

LUKE is an Equal Opportunity employer

Links: To learn more about LUKE please visit our website at: http://www.lukestaffing.com