Onboarding & Credentialing Specialist Job at Presbyterian Healthcare Services
Overview:
The ideal candidate has experience in hospital medical staff or managed care credentialing with medical staff services, physician practices or customer service. The primary focus is to assist providers in navigating through the credentialing/privileging/enrollment/human resource processes. You will proactively facilitate all aspects of the credentialing, privileging, and provider enrollment processes for newly employed physicians and mid-levels.
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Days
Qualifications:
Responsibilities:
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About New Mexico
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Now hiring a Onboarding & Credentialing Specialist!
The ideal candidate has experience in hospital medical staff or managed care credentialing with medical staff services, physician practices or customer service. The primary focus is to assist providers in navigating through the credentialing/privileging/enrollment/human resource processes. You will proactively facilitate all aspects of the credentialing, privileging, and provider enrollment processes for newly employed physicians and mid-levels.
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Days
Location:
Hybrid remote,
will require in person meetings with Providers at Presbyterian Offices located on Albuquerque, New Mexico. If you are willing to relocate to beautiful New Mexico, this is the job for you.
Qualifications:
- Two-three years college or Associates Degree or equivalent relative experience in the industry will be considered in lieu of a degree.
- One- three years of experience in medical staff services, physician practices, customer service or other related field.
- One to three years experience in hospital medical staff or managed care credentialing preferred.
- Excellent written and oral communication skills.
- Project Management skills.
- Understanding of the New Mexico medical licensing requirements.
- Proficient in MS Office Suite, particularly Word and Excel
Education:
Essential: * High School Diploma or GED
Essential: * High School Diploma or GED
Responsibilities:
- Proactively facilitates all aspects of the credentialing, privileging, and provider enrollment processes for newly employed physicians and mid-levels.
- Primary focus is to assist providers navigate through the credentialing/privileging/enrollment/human resource processes as are required by PMG, PHP and PHS.
- Conducts a thorough background investigation on providers applying for affiliation with the Central Delivery System (CDS) and Regional Delivery System (RDS). This includes reviewing applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence; Identifies issues that require additional investigation and/or follow-up; Responsible for leading, coordinating, monitoring, communicating the status of any and all necessary applications.
- Acts as a liaison between Human Resources, Provider Enrollment, Medical Staff Affairs to ensure provider is licensed, appropriately privileged and credentialed, and enrolled with payors, if applicable, and in a timely manner.
- Proactively communicates with provider and promptly resolves problems, errors, or other problems that could delay providers commencement of employment; Maintains accurate data in the credentialing database and SharePoint site which is accessed by multiple business units within the organization.
- The Onboarding and Credentialing Specialist will serve as the one point of contact for the provider through the onboarding process from start to finish.
- On-boarding coordination for newly hired physicians and mid-level providers, utilizing and updating systems for tracking and reporting progress.
- Facilitates the timely and accurate completion of all provider applications within time limits - including but not limited to acquisition of New Mexico Medical License, Controlled Substance Registration (CDS) and Drug Enforcement Agency number (DEA), hospital credentialing, payor enrollment
- Reviews incoming initial applications for completeness and accuracy to meet state and federal regulatory requirements and accreditation standards as they apply to credentialing
- Conducts a thorough background investigation on providers applying for affiliation with the Central Delivery System (CDS) and Regional Delivery System (RDS)
- Identifies issues that require additional investigation and/or follow-up
- Establishes proactive communication with providers to complete required applications as determined by the service level agreement.
- Serves as a resource to the applicants, human resources, recruiters, administrative leaders, clients, and other departments.
- Maintains a flexible schedule to allow for evening/weekend capability in order to meet the providers schedule
- Understands and maintains current knowledge of state and federal regulatory requirements and accreditation standards as they apply to credentialing
- Utilize the credentialing database (Visual Cactus), and on line application (AppCentral) to enter in and maintain credentialing information.
- Ensures that all records (electronic and/or paper) are stored in a secure location and that no confidential information is readily available when away from the office/desk
- Maintains a tickler system for follow-up on incomplete applications or unanswered correspondence in order to meet established turnaround times and maintain departmental and the CVO clients standards
- Employs public relations skills in a wide variety of phone contacts and written communications with external sources for purposes of soliciting information essential to credentials verifications, including licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials and credentials staff, physicians and their office staff.
- Shares responsibility for developing and maintaining an environment that supports service excellence.
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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Offer Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer. Minimum Offer: USD $18.58/Hr. Maximum Offer: USD $28.36/Hr.
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