DaVita Specialist Credentialing (Roma) in ALBUQUERQUE, New Mexico

Specialist Credentialing (Roma)

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of June 30, 2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately760,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

Weare committed to bringing the benefits of coordinated care to our patients andto taking a leading role in the transformation of the national healthcaredelivery system to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita Medical Group may be the employer foryou.

Overview:

Responsible for coordinatingthe credentialing, re-credentialing, and enrollment process as well theresources to achieve compliance with NCQA, payer delegation agreements, andvarious federal and state provider enrollment requirements. Provides direction to clinicians andfacilities in regards to the completion of applications for initialcredentialing, re-credentialing or payer enrollment; ensuring efficiencyand accuracy of work. Ensures consist application andinterpretation of existing policies, procedures, standards, and regulatoryrequirements. Adheres to policies, procedures, and regulations toensure compliance and patient safety. Participation in Compliance andother important training is a condition of employment.

Essential Functions:

  • Consistently exhibits behavior and communication skills that demonstrate DaVita Medical Group's commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

  • Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

  • Responsiblefor processing provider applications and re-applications including initialmailing, review, and loading into the database tracking system ensuring compliancewith required standards. Ensures the files for clinicians due forcredentialing/re-credentialing are available for review by the CredentialingCommittee each month and resolves outstanding issues prior to committee review.

  • Overseesprimary source verification activities.

  • Ensurestimely processing of all credentialing requests.

  • Responsiblefor facilitating monthly Credentialing Committee meetings.

  • Maintainsprovider enrollment files.

  • Completesand maintains clinicians privileges and hospital appointments andreappointments

  • Directlyresponsible for payer delegated audits and reports audit findings to Executive Directorand Credentialing Committee.

  • Maintainsand updates credentialing reports.

  • Researchand resolves all credentialing and payer enrollment issues.

  • Participates,presents and attends professional/departmental meetings.

  • Compilation,coordination and management of clinician data disseminated to health plans andother payers.

  • Worksin collaboration with the Contracting Department, Revenue Operations, ClinicalOperations and other areas on issues to improve processes and outcomes.

  • CoordinatesPeer Review activities and processes in compliance with all applicablerequirements in conjunction with the Peer Review Committee.

  • Otherduties as assigned.

Qualifications

Education:

  • Associate’s Degree in related field.

  • Preferred-CPCS

Experience:

  • Two (2) years of related experience

Knowledge, Skills, and Abilities

  • Ability to communicate effectively; Ability towork independently; Skilled in a variety of software applications

Primary Location NM-ALBUQUERQUE - 87102

Req ID: 302909