BH Provider Credentialing and Education Specialist

GENERAL SUMMARY:

Ensures all requirements, based upon federal and state regulations, of physicians and advanced practicing providers are obtained/maintained to compliantly practice medicine at all Bryan Heart practice locations within the scope of their licensure and specialty. Responsible for provider in-class and at-the-elbow training and support to all Bryan Heart providers and all clinical support staff, for the Electronic Health Record (EHR) system specific to ambulatory/inpatient-cupid/clinical (nursing) support.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Secures initial state licensure and maintenance of state licensure for applicable states where physician/APP will see patients.

3. *Secures initial and maintenance of state applicable federal DEA registrations and state controlled substance numbers.

4. *Facilitates the initial medical staff appointment and reappointment process for physicians/APP at Bryan Medical Center and critical access hospitals as needed to meet the needs of Bryan Heart’s outreach program.

5. *Communicates and routes information for completion/signature to Bryan Heart physician/APP staff to complete the credentialing/payer enrollment/medical staff appointment-reappointment process.

6. *Initiates and facilitates the payer enrollment process for new physicians/APP’s and re-enrollment of physicians/APP’s with Bryan Heart government and contracted payers/insurance companies.

7. *Maintains centralized database of all provider licensure/registrations/payer enrollments/medical staff appointments as approved by Business Operations Director.

8. *Maintains and tracks physician/APP continuing medical education hours required for applicable state licensures in a centralized database.

9. *Point person/liaison for payers, vendors and external clients/facilities related to any credentialing duties/requirements/needs.

10. *Maintains strict confidentiality of personal and legal information/practice history information of physicians/APP’s.

11. *Leads end-user training using the curriculum designed by principal trainers as well as proficiency assessments and in-system checklists, at-the elbow go-live and post-live support and optimization training. Helps end users envision how they will utilize the system in their daily work.

12. *Prepares and sets up the physical training environment, as modality requires (virtual vs. in person).

13. *Follows up on any outstanding questions that arise during training. Collects feedback from class attendees and communicates that information to the principal trainer.

14. *Helps principal trainers review and update training materials specific to Bryan Heart/Cardiovascular processes. Creates end user quick start guides and tip sheets when indicated and beneficial to the end user.

15. Tests Bryan Heart lesson plans and training environment build.

16. Administers end-user proficiency assessments and in-system checklists.

17. Supports Bryan Heart providers and clinical support staff with at-the-elbow go-live support as well as upgrade support.

18. Administers Bryan Heart specific post-live refresher, optimization and skills enhancement training.

19. *Performs trouble shooting and triage of Bryan Heart EHR performance and functionality; escalates issues to IT service desk as required. Assists as a resource for resolution as needed.

20. *Develops and maintains content for computer based training modules specific to Bryan Heart and cardiovascular service line. Designs interactive and engaging online courses using adult learning principles and authoring tools; collaborates with Principal Trainers to incorporate Bryan Heart specific information into online courses.

21. *Utilizes Learning Management System (LMS) to perform training coordination responsibilities related to Bryan Heart end user training enrollment for eLearnings and Instructor Led Training (ILT). These responsibilities include, but are not limited to, publishing online courses, course assignment to end users, building and reconciling live classes.

22. Collaborates with Bryan Health System Quality/Clinical Improvement Consultants to ensure training Bryan Heart providers and clinical support staff across the cardiovascular service line meets reporting/performance metrics and goals via documentation.

23. Collaborates with Bryan Heart business operations team to ensure training and documentation workflows align with compliant billing practices as well as maximize revenue.

24. Assists with provider personalization and Dragon training while maintaining documentation integrity to ensure patient safety and secure appropriate revenue.

25. Serves as an ambassador of the new system.

26. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

27. Participates in meetings, committees and department projects as assigned.

28. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of the impact of credentialing to the revenue stream.

2. Knowledge of Nebraska, Federal and external state licensure/registration requirements/guidelines.

3. Knowledge of the professional services revenue cycle.

4. Knowledge of computer hardware equipment and software applications relevant to work functions.

5. Skill in creating documents in Microsoft Office products and web based technologies.

6. Skill in delivering consistent customer service through demonstration of strong work ethic and service orientation.

7. Skill in public speaking and presenting to audiences of all levels of the organization preferred.

8. Ability to effectively lead and facilitate meetings.

9. Ability to communicate effectively both verbally and in writing.

10. Ability to prioritize work demands and work independently with minimal supervision.

11. Ability to work independently, take direction and work collaboratively with others.

12. Ability to network and develop effective working relationships with all co-workers, clinical and non-clinical colleagues.

13. Ability to resolves problems/issues independently using sound judgement and following established departmental guidelines in a timely manner.

14. Ability to effectively organize and prioritize work projects and manage time.

15. Ability to maintain confidentiality relevant to sensitive information.

16. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

Associate’s degree required, Bachelor’s degree preferred. Adult education and classroom training experience desired. Epic or other related EMR systems experience preferred. Minimum of six (6) months credentialing experience or one (1) year medical billing experience.

OTHER CREDENTIALS / CERTIFICATIONS:

Pass Credentialed Trainer (CT) credentialing program for each specific discipline (ambulatory-inpatient-cupid-clinical support staff) upon hire with a minimum score of 85%.