Credentialing Specialist II

at Northern Light Health in Brewer, Maine, United States

Job Description

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Department: Credentialing

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Summary:

The Credentialing Specialist II reports to the Manager of Credentials Verification Organization (CVO) and will perform activities as assigned including meeting management and credentialing and privileging functions to comply with hospital and health system CVO requirements, and external accreditation standards, state laws and Centers for Medicare and Medicaid (CMS) Conditions of Participation for Hospitals.

Responsibilities:

Practitioner credentialing, privileging, and performance evaluation

+ Assist with application management and verification activities, preliminary analysis of application and verification information, flagging potentially adverse information for medical staff services leadership review, preliminary identification of areas where practitioners may not meet privileging or membership criteria.

+ The Credentialing Specialist shall monitor expiring information such as but not limited to DEA, license, professional liability insurance, and specialty board certification status; maintain and update credentials file(s) (paper and/or electronic as applicable).

+ Preparation of practitioner information for review and evaluation by medical staff leaders and support of follow-up on actions taken by the organized medical staff regarding practitioner competency management.

+ Assures that data entry of required source verification data elements and practitioner credentials files are managed accurately in accordance with procedures as outlined in the CVO Operations Manual.

+ Effectively communicates issues and ongoing status of assigned work to department leadership.

Meeting Management and/or Agenda Support (as assigned):

+ Attend and participate in meetings; coordinate, complete follow-up tasks and provide support as needed for meeting preparation(s).

+ Assure that all minutes accurately reflect actions taken, the names of those present, appropriate follow up, and the responsible party.

+ Effectively communicates relevant information, issues, follow up, and ongoing status accordingly.

Policies, Procedures and Documents

+ In conjunction with the Director and/or Manager, assist in the maintenance and protection of medical staff policies, procedures, credentials files and departmental documents

Miscellaneous and Other Tasks:

+ Maintains a working knowledge of all computer applications needed for position including facility specific credentialing software database, Word, Excel and PowerPoint (as applicable)

+ The Credentialing Specialist may be assigned to various tasks such as reception, filing, correspondence or other activities required to support the general operations of the CVO.

+ Continually strives to achieve individual team and departmental goals.

Other Duties

Other Information:

+ Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.

Competencies and Skills

+ Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.

+ Adobe Acrobat

+ Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one’s behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

+ Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization’s benefit.

+ Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees’ strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.

+ Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences’ level.

+ Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.

+ Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.

+ Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.

+ Word processing, spreadsheets, data entry, database experience and other computer related skills.

+ Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.

+ Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.

+ MS Teams

+ Multi-line phone, scanner, photocopier, fax, and internet.

+ Experience with operating a network.

+ Public Speaking

+ Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.

+ Troubleshooting

+ Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

+ Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment,