HHA Credentialing Specialist

---

Job description

SUMMARY:

The HHA Credentialing Specialist ensures that practitioner credentialing files are completed and returned to Heartland Health Alliance (HHA) clients in a timely and accurate manner.

RESPONSIBILITES INCLUDE BUT ARE NOT LIMITED TO:

Commits to the mission, vision, beliefs and consistently demonstrates our core values.
Facilitates practitioner packets for appointment and reappointment.
Coordinates procurement of Drug Enforcement Administration (DEA) information, licensure and malpractice insurance information.
Provides practitioners with appropriate delineation of privilege forms.
Completes primary source verification on practitioner applications.
Ensures that all practitioner credentialing files are completed and submitted back to the client within 30 business days of receipt of the completed application and supporting documents.
Completes follow-up on delinquent credentialing file items (i.e. application information, hospital affiliations and peer references).
Prepares credentialing files for clients.
Provides phone coverage for the Heartland Health Alliance office; relays messages in a timely fashion and provides information to callers as appropriate.
Identifies and notates the practitioner file with any potential red flag findings in the verification process.
Sorts and routes incoming departmental mail; delivers out-going department mail.
Maintains departmental files including processing file revisions.
Performs copying, faxing, printing and distribution of information.
Proactively requests upcoming expirable items and communicate with the client to ensure that the file is kept current (i.e. State License, DEA License and Malpractice Insurances).
Maintains information on sanctions and insurance liability claims.
Provides quality assurance audit for each practitioner file prior to file release to the client. Utilizes relevant software to produce communication; sets up databases and tracks regulation compliance
Facilitates solving of software and technology issues as they arise to ensure efficient functioning of programs.

QUALIFICATIONS:

High school diploma or equivalent required. Prior medical office experience required.

<!– job description page –>