PURPOSE AND SCOPE: Collaborates with a third party/external credentialing agents to ensure credentialing process is completed as required. Supervises team of credentialing specialists who perform all provider credentialing verification in accordance with regulatory and accreditation standards as well as internal FMCNA policy and procedure. Responsible for ensuring the enrollment of providers with payers and facilities is maintained at established criteria for both internal and external FMCNA clients.
Performs audits of both the internal FMCNA Provider Database and FMCNA provider information to ensure that credential verification is completed in a timely manner according to all regulatory and company requirements. PRINCIPAL DUTIES AND
Applies considerable Credentialing knowledge to lead and a supervise a broad range of tasks which include but are not limited to primary source verification, payer enrollment, facility privileging processes, data quality review, and software improvement processes pertaining to internal and external FMCNA clients. Supervise the daily operations of a team of credentialing specialists, including but not limited to establishing mutual goals, assigning tasks and maintaining schedules.
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. Oversees Daily Metrics and workflow of employees to ensure high department efficiency & output Performs provider/practitioner credentialing verification tasks to facilitate compliance with Medical Staff by-laws regarding the verification of a minimum set of a practitioner's credentials required prior to the patient receiving their second treatment.
Responsible for tasks related to the three-year cyclical verification process of all active practitioners. Utilizes knowledge regarding national accreditation standards, internal medical staff bylaws and other related policies and regulations to perform functions pertaining to the provider/practitioner credentialing process for the FMS Division. This includes but is not limited to: Obtaining practitioner license information from publicly available state/government agency websites, the National Provider Databank, and other 3rd party certification groups such as the American Board of Internal Medicine Completing and processing all initial credential applications for new providers/practitioners and credential verification applications for existing providers/practitioners 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/practitioner meets federal and state regulations as well as FMCNA internal requirements Maintaining and updating the database on individual provider/practitioner credentials' status, tracking pending/completed applications, and maintaining a complete and accurate database of historical applications.
Provides regular reports and updates to pertinent FMS field operations management and Director Operations Monitoring. Communicating with practitioners regarding credentialing status, providing updates and obtaining additional information as required. Educates and informs FMS field staff responsible for reporting new practitioners regarding their responsibilities in the credential verification process.
Explains the credentialing requirements, practitioner specific information, information regarding the FMCNA third-party credential agent, regulations and industry standards for credentialing of health care providers and other information as applicable Continually audits and analyzes the credentialing process to identify deficiencies in controls and to identify process/workflow issues recommending improvements to manager and implementing if approved.
Provide direct supervision of the assigned team(s) through ongoing leadership and guidance including providing additional weekly 1:1 feedback to employees on metrics, emails, and any additional concerns, including partnering with Human Resources on employee matters. Review internal Provider Database information and database of FMCNA provider information compiled by external credential verification agent to identify and take appropriate action where required to correct areas of noncompliance with company policy, such as reporting requirements of identified deficiencies in provider applications, reporting of providers non-compliant with verification policies, expired board certifications and other requirements as applicable.
Responsible for generating various standard and ad hoc reports from database Prepares project status reports as required, detailing progress of credential verification status of individual practitioner credential applications for each FMS Division, and reporting variances and trends in the credentialing process as identified to the Director Operations Monitoring. Prepares reports detailing credential verification issues to pertinent field staff and credential verification agent The monthly provider/practitioner credentialing status report for review by Director 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. Assist with various projects as assigned by a 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
. SUPERVISION: May be responsible for the direct supervision of various levels of credentialing specialist staff.
Bachelor's Degree required. EXPERIENCE AND
2 - 3 years' experience in credential verification or in a Physician practice/Medical office or other similar experience in a healthcare setting; or 1 - 3 years' experience as a Supervisor. 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 internal and external contacts. Perform work at a high level of accuracy and timelines. Attention to confidentiality and regard for protecting confidential and sensitive information 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 The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies. Annual Rate: $72,000.00 - $121,000.00 Non-Bonus Eligible Positions: include language below.
Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave. Bonus Eligible Positions – include language below. Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance.
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors