BH Credentialing Specialist

GENERAL SUMMARY:

Ensures all requirements, based upon federal and state regulations, for physicians and advanced practicing providers are obtained/met to compliantly practice medicine within the scope of their licensure and specialty. In addition, ensures medical staff appointments are secured and remain current at Bryan Medical Centers, additional Bryan Health medical facilities and regional outreach hospitals to meet the needs of Bryan Heart’s outreach program. Ensures payer enrollments are completed timely and maintained to ensure revenue capture for Bryan Heart.

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 physicians and advanced practice providers (APPs).

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

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

5. *Communicates and routes information timely 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 continuing medical education hours required for applicable state licensures in a centralized database.

9. *Acts as point person/liaison for revenue cycle staff, payers, vendors and external clients/facilities related to any credentialing duties/requirements/needs/discrepancies.

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

11. Resolves problems/issues independently using sound judgement and following established departmental guidelines in a timely manner and escalates to direct leader when necessary.

12. Provides support in various areas within the Bryan Heart revenue cycle.

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

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

15. 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 Nebraska, Federal and external state licensure/registration requirements/guidelines.

2. Knowledge of DEA registration process and requirements.

3. Knowledge of the professional services revenue cycle.

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

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

6. Ability to perform crucial conversations with desired outcomes.

7. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

8. Ability to problem solve and engage independent critical thinking skills.

9. Ability to maintain confidentiality relevant to sensitive information.

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

11. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Associates or Bachelor’s degree in a healthcare or business related field preferred. Minimum of six (6) months credentialing experience or one (1) year healthcare experience preferred.