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Lead Credentialing Specialist

Lead Credentialing Specialist

Job ID 
2017-1468
# of Openings 
3
Job Locations 
US-NJ-Marlton
Posted Date 
8/8/2017

More information about this job

Overview

Lead Credentialing Specialist

 

InSight Telepsychiatry Medical Affairs

 

Position Summary

InSight Telepsychiatry and the CFG Health Network are seeking a Medical Affairs Lead Credentialing Specialist to work in Marlton, NJ and connect regularly with a national team of colleagues. This position will report to the Director of Medical Affairs.  This fast-paced position is an excellent opportunity for an organized, problem-solving individual with an interest in medical affairs, behavioral health and telemedicine. This position is responsible for supervising a team of internal credentialing coordinators that support InSight’s employed and contracted behavioral health practitioners in obtaining and maintaining their licensure, prescriptive authority, clinical privileges, and payer enrollment.  InSight’s provider team becomes credentialed, enrolled, and privileged by our customers, and the Credentialing Manager is responsible for ensuring that our credentialing coordinators submit accurate, timely, and complete information to these partners on behalf of our providers.  InSight’s medical affairs function is a service department designed to support our network of providers.  Our providers and our operational counterparts are the customers of medical affairs. 

 

Organization Overview

The CFG Health Network is a family of companies that provides behavioral health services across the spectrum of care. InSight Telepsychiatry is the telemedicine arm of the CFG Health Network and has a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. With 17+ years of telepsychiatry experience and an active footprint in telepsychiatry-related advocacy, InSight is recognized as an industry thought-leader. Collectively, the CFG Health Network companies share a management team and certain back-office functions. In addition to telepsychiatry, the CFG family of companies provides outpatient behavioral health services, hospital based programs including inpatient psychiatric services, ED evaluations, psychiatric crisis center intervention, medical/surgical services and healthcare services for correctional facilities.

 www.InSightTelepsychiatry.com

Responsibilities

Responsibility 1: Application Processing - 70%

 

  • Analyze the practitioner profile and accompanying documents, ensuring applicant eligibility
  • Work closely with provider to obtain missing documentation and/or signatures pertaining to applications
  • Populate applications, review for accuracy and completeness, submit to decision making body, and maintain follow-up to completion
  • Confirm receipt of requested documents, identify and respond to issues that require additional investigation and evaluation, validate discrepancies with provider and facilitate process for payer participation
  • Perform timely follows-ups, update database on the status of application and to report to management and provider
  • Monitor documentation renewal/expiration dates and complete renewal applications
  • Maintain current copy of appointments and privileges in database
  • Monitor initial, reappointment, FPPE and OPPE process for provider ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state) as well as medical staff bylaws, rules and regulations, policies and procedures and delegated contracts
  • Maintain and utilize credentialing database to optimize efficiency, perform document generation, track application status and report
  • Maintain library of current electronic forms

 

Responsibility 2: Staff Support - 20%

  • Support credentialing coordinators responsible for licensing, credentialing, privileging, enrollment, reappointments, and/or maintenance of professional credentials.
  • Train and coach credentialing coordinators to improve their professional knowledge and skills
  • Monitor and ensure compliance with P&P and standard operating procedures.
  • Assist in creating or revising workflows, procedures, policies, and or standards as needed
  • Assist in assigning medical affairs jobs to the appropriate credentialing coordinator
  • Monitor and balance the workload of credentialing coordinators to ensure efficiency and maximum productivity
  • Regularly communicate updates, including expected completion dates, internally and externally
  • Assist the Medical Affairs Director in identifying barriers or challenges to timely completion of medical affairs jobs and help put solutions in place, including escalation and communication protocols.

 

Responsibility 3: External communication, reporting, and special projects - 10%

  • Serve as a liaison for medical affairs with counterparts within external partners
  • Participate in kick-off meetings with new partners and other key meeting as needed
  • Meet with Medical Affairs Director regularly to provide updates
  • Support the Medical Affairs Director in helping to establish goals and benchmarks for credentialing team and regularly monitor and report on progress against those goals
  • Support quality assurance initiatives and create an environment where QA outcomes drive performance of credentialing coordinators
  • Participate and support Credentialing Committee meetings as needed
  • Overflow of Credentialing Jobs and other duties as assigned

 



Qualifications

 

Job Requirements

  • High school education required, bachelor’s degree preferred
  • 5 years of relevant healthcare experience is required including specialized skills in Credentialing in a mental health setting, hospital setting, medical staff office or credentials verification organization
  • Ability to work independently, as well as, in a team setting
  • Exceptional organization and time management skills to manage priorities and meet deadlines
  • Able to communicate effectively both verbally and in writing and work with individuals of diverse backgrounds
  • Strong attention to detail and quality
  • Proficiency with Microsoft Office suite (Word, Outlook); Excel preferred

 

Ideal Candidate

  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Service Management (CPMSM) certification a plus
  • Knowledge of Echo Credentialing Software
  • Knowledge of The Joint Commission's Standards as they relate to Credentialing and Privileging
  • Knowledge of NCQA standards as it relates to credentialing and health plan enrollment
  • Knowledge of medical terminology as it relates to specific privileges

 

Logistics

  • Position is based in Marlton, NJ
  • Full Time
  • Opportunity for some telework/flexible schedule opportunities
  • Reports to the Director of Medical Affairs 

 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

 

EOE M/V/F/D