Job ID 20000F8O
Available Openings 1
PURPOSE AND SCOPE:
Under the general supervision of the Manager Physician Services, assists with the credentialing and re-credentialing of physicians by coordinating, monitoring, and maintaining the credentialing process ensuring compliance with Joint Commission (TJC) and other regulatory, legal and company requirements and standards. Assists with coordination of physician privileging according to company procedures and regulatory requirements. Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and company policy requirements.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Completes and processes physician and provider applications and re-applications, using verifications from the American Medical Association (AMA), National Practitioner Database (NPDB), state medical board websites, and other documents. Responsibilities may include but are not limited to:
- Administers the initial mailing of the applications.
- Conducts the detailed review and follow-up determining eligibility by applying TJC, regulatory, and company standards as they relate to physicians. Upload the pertinent information into the database application.
Administers and maintains the physician provider profiling system and database:
- Identifies, analyzes and resolves provider file issues and changes communicating with the applicable personnel or physician as required to accomplish appropriate resolution.
- Audits files to ensure consistency and availability of all required documentation
- Reviews provider file changes obtaining missing information as needed.
- Tracks progress of credentialing producing reports in profiling system and database for credentialing management.
- Removes and stores obsolete files with expired and unnecessary documents and reports according to company document storage requirements.
Monitors credentialing status and information regarding physician providers:
- Ensures the applicable timelines are met regarding document renewals and initial credentialing process.
- Informs physician providers regarding upcoming expiration dates of specific credentialing documentation and requesting the updated documents to be uploaded into the database application.
- Alerts manager and Physician Services senior management regarding any information regarding state license board or other agency disciplinary action notifications or similar issues pertaining to physician providers.
- Responds to external inquiries received according to department policy and procedures escalating to the more complex queries to management as appropriate.
- Responsible for administering the re-credentialing of providers every two years ascertaining if there are any changes which have to be made.
- Assists in the implementation and maintenance of company processes and procedures including The Joint Commission certification regulatory guidelines regarding physician privileging. Assists with physician privileging including obtaining the requisite information and documentation regarding the administration and results of the peer review process for physicians.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
- The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High School Diploma required
EXPERIENCE AND REQUIRED SKILLS:
- Minimum 3 years required experience in healthcare administrative role, working with physicians and related administrative functions.
- Must be proficient with standard desktop office applications including Microsoft Office software applications.
- Must have excellent and effective verbal and written communication skills to communicate with providers and office staff.
- Must perform work at a high level of accuracy and within the required timelines.
- Must have good organizational skills with the ability to manage multiple tasks and prioritize.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
Apply on company website