Processes credentialing and re-credentialing applications of practitioners, reviews application, prepares verification letters, track responses, follows-up for needed information. Conduct background investigations on practitioners including licensure, education and post- graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence, in accordance with NCQA, Joint Commission and URAC credentialing standards and other established principles of legal documentation and confidentiality. Maintains credentialing database by entering accurate and up-to-date data for each applicant into the database. Responsible for the accuracy and integrity of the data entered. Assists credentialing staff with duties such as scanning,making copies, preparing mailings, attending staff meetings, preparing minu tes, etc.
1. Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability. 2. Assists in the credentialing/recredentialing process ensuring work is performed in accordance with CHRISTUS Policies and Procedures, as well as NCQA, Joint Commission and URAC credentialing standards, and other applicable state and federal regulations. 3. Maintains a working knowledge of NCQA, Joint Commission and URAC credentialing standards. 4. Audits credentials files in accordance with CHRISTUS Policies and Procedures and in accordance with NCQA, Joint Commission and URAC credentialing standards. 5. Diplomatically employ public relations skills in a wide variety of personal/phone contacts with external sources for purposes of soliciting information essential to credentials investigations, including state licensing agencies, university and hospital training program administrators, certification boards, liability insurance carriers, hospital officials and credential staff, practitioners and their office staffs. 6. Assist in monitoring of expirations of various state licenses, certificates, malpractice insurance and board certifications; initiates proper correspondence and follow-up. 8. Enters a variety of data into Credentialing database. Responsible for the integrity and ac curacy of the data entered. 9. Assist in maintenance of credentials files. 10. Seeks direction from Credentials Coordinator or Manager when problems are outsid e standard processes. 11. Extensively review and analyze practitioner's credentials documents including certificates of education, residency and fellowship training, and board certification and eligibility; licensure, professional work history, liability insurance and malpractice records. Assess completeness of information and applicants' qualifications relative to established policies and procedures, NCQA, Joint Commission and URAC credentialing standards as required. 12. Assist with preparation for delegated credentialing audits of credentials files. 13. Coordinate with appropriate personnel to schedule office site visits, as needed, for appointment and reappointment of practitioners. 14. Oversees the credentialing process, identifying areas of opportunity to modify established department procedures, processes and policies. 15. Performs audits of Credentialing Assistants work to ensure accuracy with internal policies, NCQA and TJC guidelines 16. Performs audits of Credentialing Assistants log information into Activity Logs, Credit Card Logs, etc for accuracy. 17. Provides insight to Credentialing Assistants regarding the credentialing process and related questions 18. Performs any other duties as may be required.
A. Education/Skills College degree preferred. Basic computer knowledge. Ability to communicate effectively, both verbally and in writing. Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of the academic requirements. Medical terminology recommended. Knowledge of ECHO, Word, Excel, and Access preferred. Must be organized and be able to work quickly, independently, and with little supervision.
Two years experience in healthcare setting. Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of the academic requirements
High school diploma or equivalent. Coding certification within one year of employment.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.