CREDENTIALING SPECIALIST SUPERVISOR needed for Complex Care Solutions in Manhattan, NY. We are a Healthcare Wellness company, growing in the adult/geriatric home assessments area. We prefer someone with team lead or supervisory experience. This specialist's responsibilities will be as follows:
- Captures required credentials and enters them into the credentialing database
- Confirms that credentialing requirements are met prior to the clinician conducting home visits and/or contacting members.
- Works with Human Resources to ensure that pre-employment requirements are met
- Conducts monthly Medicare sanctions checks
- Demonstrates knowledge of CMS and NCQA credentialing requirements
- Identifies exceptions to credentialing requirements and prepares an exception request for submission to the Executive Quality Committee
- Notifies the Director Quality, Compliance and Coding Services of non-compliance issues
- Prepares credentialing reports for submission to clients
- Identifies and communicates re-credentialing needs to the clinician in a timely fashion to maintain credentialing compliance.
- Makes recommendations for changes in credentialing policies and procedures
- Identifies opportunities for data tracking and database enhancements
- Provides guidance to clinicians in completing credentialing requirements
- Maintains knowledge of current issues, trends, and changes in the laws and regulations governing clinician credentialing.
- Adheres to HIPAA privacy regulations
- Read, interpret, and apply policies, procedures, laws, and regulations;
- Proficient in MS Office applications
- Maintain working relationships with clinicians, other staff; review the work of others; maintain confidentiality; influence/coordinate efforts of others over whom one has no direct authority.
The physical demands described here represent those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to stand; walk; and use hands to finger, handle, or feel objects, tools, or controls. The employee is occasionally required to reach with hands and arms. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job involve normal vision.
- Development of credentialing skills that emphasize quality, continuous improvement, and high performance.
- Personal ongoing development.