- Professional Duties- Send out applications for credentialing documents to applicable providers for initial credentialing and re-credentialing.
- - Maintain MSOW credentialing database updated in accordance with Heritage Provider Network (HPN) policies.
- - Coordinate initial and re-credentialing process. This includes, but is not limited to collection of necessary documentation and verifications in accordance with the National Commission of Quality Assurance (NCQA) standards.
- - Process Locums Tenens (temporary credentialing) and STAT credentialing requests and notify appropriate internal departments of request status.
- - Run Medicare Opt Out, OIG/OEIE, EPLS, Medi-Cal Suspended and Ineligible report, DHCS Restricted Provider List, CMS Preclusion List and Social Security Death Master File Reports.
- - Complete credentialing files within 180 days from signature of credentialing/re-credentialing release in accordance with NCQA standards.
- - Prepare files for credentialing committee meetings and ensure that information is accurate and through. Files include, but are not limited to: Committee checklists and summaries of malpractice cases, disciplinary actions, sanctions for credentials chairperson/Medical Director.
- - Request Provider Office/Facility Site Visit by DOHC Quality Department if applicable.
- - Process credentialing/re-credentialing of all Ancillary Facility files.
- - Compile and complete nursing home Reports for presentation to Credentials Committee Bi-Annually.
- - Update and maintain the Council for Affordable Quality Healthcare Credentialing database for all Desert Oasis Healthcare Care providers.
- - Assist with various provider continuing education programs and/or nursing continuing education programs.
- - Perform other duties as assigned.
- - Serve as an ambassador for Desert Oasis Healthcare and Family Hospice Care at all times and positively shape the customer experience
- - Be knowledgeable about your job so that you can serve others effectively
- - Help others, offering to assist (Ask, how may I help you?)
- - Do your share. Do what you say you will do and take action, follow through. Be willing to pitch in and help
- - Let your patients, customers and co-workers know what they can expect from you and follow through
- - Be accountable for your work
- - Be sensitive to factors that influence customers and co-worker’s situation including age, gender, culture, race and socioeconomic status. Be observant of others’ social cues (emotions) and respond appropriately
- - Speak clearly and use understandable language (avoid medical jargon or slang)
- - Summarize key information and provide written materials whenever possible
- - Validate to ensure understanding
- - Answer all phone calls with a salutation, introduction and offer to assist (Good afternoon, Desert Oasis Healthcare or Family Hospice Care, this is (your name), how may I help you?)
- - See the positive in situations and in others
- - Avoid gossip and negativity
- - Offer to answer any additional questions that the person, patient or customer may have
- - Anticipate needs that will arise before your next meeting
- - Inform patients and co-workers of how and when to contact you under normal circumstances (phone number, email, a help line, Immediate Care, etc.) or when unforeseen issues arise
- Qualifications- High school diploma or equivelant.
- - 3 years of experience in a healthcare professional office setting. Credentialing experience, preferred.
- - Ability to utilize Microsoft Office applications (Excel, Outlook, Power Point, Word, etc.) with proficiency.
- - Ability to work independently with minimal guidance and supervision.
- - Ability to manage time and prioritize tasks to meet established deadlines.
- - Ability to effectively communicate with individuals within all levels of the organization, providers and others.
- - At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
- Physical DemandstypeSitting- Approximately 50% of day.
- typeStanding- Approximately 40% of day.
- typeWalking- Approximately 10% of day.
- typeLifting- 0 - 10 lbs. approximately 40% of day
- typeBending- Approximately 10% of day. Kneeling < 20%.
- typeHearing/Visual Acuity- Adequate for use with computers, telephone/mobile device, and other office tech equipment approximately 50% of day.
- typeComputer- Highly technical work environment. Must be able to work 6 hours per day using computers, telephone/mobile device, and other office tech equipment.
- typeReaching- Above head 75 degrees - approximately 5%.
- typeHand grip dexterity- Approximately 50% of day.
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