Purpose: Maintains credentialing for Physicians and Mid-level Providers to ensure compliance with state and federal guidelines. Adhere to established quality practices while continually seeking to improve and expand upon work performance and knowledge. Responsible for overseeing the day-to-day operations of the credentialing department by creating a positive environment that encourages staff to perform at their highest potential.
Processes provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained.
Delegates tasks to staff for credentialing new and current providers.
Develops and continuously updates credentialing process/protocol guide.
Conducts audits and provides feedback to reduce errors and improve processes and performance.
Maintains confidential as well as accurate credential files and/or information in the system, in a timely fashion with compliance to applicable policies.
Monitors the license / certificate expireables to maintain all credentials, certificates, and health facility privileges current.
Coordinates and/or works with the appropriate personnel and /or department regarding all processes relating to credentialing.
Initiates suspension as necessary and inform individuals
Add Providers to current insurance contracts.
Complies with medical and insurance policies.
Performs EMR tasks when on-boarding/off-boarding providers and various reporting.
Responsible for projects relating to CLIA, RX Triplicate Pad, and TER death registry.
Creates and maintains electronic forms in SyMed.
Responsible for overseeing the day-to-day operations of staff.
Provides timely and tailored training, feedback, and constructive criticism to improve and expand upon employees’ technique and knowledge; participates in the performance appraisal process of employees by maintaining notes on individual employees throughout the year and constructing fair, effective, unbiased, and factual performance comments.
Assists in timely and progressive counseling aimed at correcting performance problems.
Leads and motivates staff while continuously improving on leadership skills.
Serves as a subject matter expert to the staff.
Organizes/oversees processes and employees, leads and motivates staff, ensures thorough/effective dissemination of information, and maintains open lines of communication with employees and Physicians.
Assists other CBO departments (i.e. billing) as needed.
Performs other duties as assigned.
Skills, Education, & Experience:
High School diploma or GED is required.
Requires 3-5 years’ experience in credentialing or medical office. College courses or degree may substitute for experience.
Come work with the fastest growing OB/GYN organization in Central Texas if you’re driven and passionate about Women’s Health! Be a part of a growing culture of empowered employees taking care of women. With CTOA, you can experience Employee Recognition, company events, and Employee Appreciation. CTOA benefits include, health insurance, paid time off, retirement plan, flexible schedules, holidays, continuing medical education assistance, and MORE!