Credentialing and Privileging Coordinator at HealthPoint

College Station, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Apr, 26

Salary

0.0

Posted On

05 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Privileging, Compliance, Documentation, Communication, Quality Assurance, Training, Professional Development, Collaboration, Attention to Detail, Problem Solving, Organizational Skills, Healthcare Regulations, Data Verification, Customer Service, Teamwork

Industry

Health and Human Services

Description

Job Details Job Location: Brazos Valley Community Action Agency - College Station, TX 77840 Position Type: Full Time BASIC FUNCTION The Credentialing and Privileging Coordinator is responsible for coordinating all activities related to the credentialing and re-credentialing of HealthPoint clinical staff, a Federally Qualified Health Center (FQHC), ensuring their privileges align with their qualifications. Clinical Staff includes licensed practitioners (for example, Physician, Dentist, Physician Assistant, Nurse Practitioner), other licensed or certified practitioners (for example, Registered Nurse, Licensed Practical Nurse, Registered Dietician, Certified Medical Assistant), and other clinical staff providing services on behalf of HealthPoint (for example, Medical Assistants or Community Health Workers that do not require licensure or certification). PRIMARY RESPONSIBILITIES AND DUTIES Credentialing and Privileging Oversight Responsible for the coordination of the credentialing and recredentialing process for all HealthPoint clinical staff joining HealthPoint, ensuring compliance with federal and state regulations. Coordinate with various departments to gather and verify necessary documents, including but not limited to licenses, certifications, education, training, and relevant work history. Conduct primary and secondary source verification of credentials to ensure accuracy and validity. Ensure verification of HealthPoint’s clinical staff of the following, as applicable: Current licensure, registration, or certification from a primary source Education and training for initial credentialing using: Primary sources for Licensed Independent Practitioners (LIPs) Primary or other sources (as determined by HealthPoint) for other licensed or certified practitioners (OLCPs) and any other clinical staff; Completion of a query through the National Practitioner Data Bank (NPDB), an electronic information repository containing information on medical malpractice payments and certain adverse actions related to health care practitioners, entities, providers, and suppliers; Clinical staff members identity for initial credentialing using a government-issued picture identification; Drug Enforcement Administration (DEA) registration; and Current documentation of basic life support training. Ensures initial and recurring review, every two years, of all clinical staff. Ensures the following for privileging clinical staff, as applicable: Verification of fitness for duty, immunization, and communicable diseases status; For initial privileging, verification of current clinical competencies via training, education, and as available, reference reviews; For renewal of privileges, verification of current clinical competence via peer review or other comparable methods (for example, supervisory performance reviews; and Maintain records of all clinical staff’s denial, modification, or removal of privileges based on assessments of clinical competence and/or fitness for duties Maintain updated credentialing and privileging files and databases, ensuring completeness and accuracy of information. HealthPoint Contract Providers Documentation, whether through formal, written referral agreements, with other provider organizations that provide services within scope of HealthPoint’s project, ensure that such providers are: Licensed, certified, or registered as verified through a credentialing process, in accordance with applicable federal, state, and local laws; and Competent and fit to perform the contracted or referred services, as assessed through a privileging process. Respond to Inquiries and Reports Collaborate and communicate with internal stakeholders, including medical staff, human resources, compliance, and legal departments, to ensure alignment with compliance with the credentialing requirements. Communicate credentialing decisions and updates to providers in a timely and professional manner. Quality Assurance and Compliance Participate in internal and external audits related to credentialing and privileging. Training and Education Provide training and education to providers and staff on credentialing requirements, processes, and best practices. Offer guidance and support to provide throughout the credentialing process, addressing any questions or concerns. Professional Development Stay abreast of changes in healthcare regulations, accreditation standards, and industry trends related to credentialing and privileging. Participate in professional development activities, such as conferences and workshops, to enhance knowledge and skills in credentialing practices. Performs other duties as assigned. Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.) MISSION, VISION, AND VALUES Empathy - Demonstrates a high level of empathy, respect, and understanding of diversity in the workplace by treating all patients, guests, and colleagues with dignity, courtesy, and inclusivity, and by actively seeking to learn from different perspectives and experiences. Excellence - Consistently upholds high ethical and safety standards and demonstrates unwavering integrity in all work-related activities. Strives for excellence in job performance. Enjoyment (Gratitude) - Displays gratitude, a commitment to learning, and professionalism by actively seeking feedback, accepting constructive criticism, and demonstrating a willingness to grow and improve in their job role. Commitment to Patient/Customer Service - Exhibits exceptional patient/customer service skills, consistently providing professional support. Demonstrates effective communication skills, actively listening to patients/customers, and responding promptly to inquiries and concerns. Handles challenging situations with tact and diplomacy, ensuring timely resolution of problems and fostering positive patient/customer experiences. CULTURE Gratitude - Displays a positive and appreciative mindset and supports happiness and well-being in self and others. Collaborative Team - Demonstrates flexibility, enthusiasm, and willingness to cooperate while working with others in an inter-professional team to support organizational activities. Identifies and supports opportunities for the professional development of team members. Quality Improvement - Collaborates with team to drive continuous improvement initiatives to enhance quality standards, processes, and outcomes. Accountability - Ensures consistent adherence to regulatory guidelines and HealthPoint policies and procedures. Takes accountability for mistakes and errors. GENERAL PROFESSIONAL DEVELOPMENT Displays more advanced organizational skills, in order to organize projects or the work of others. (Level 3) Devises effective solutions to situations encountered based on the general goals and objectives of the function. (Level 4-5) Able to effectively communicate opinions drawn from conclusions using inference and logic. (Level 3) Resolves conflicts that may arise because of disagreements between employees, between employees and customers/clients, or with the public, other legal entities or governmental authorities. (Level 3 & 4) PROFESSIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES Possesses advanced work-related skills beyond completion of high school, including written and verbal communications skills, computational and computer skills, mathematical, technical or health care related knowledge frequently acquired through completion of a licensed skilled trade, para-profession or practical business knowledge. Possesses an understanding of the trade/profession at a level that allows the employee to select methods for others to use (from those already in existence in the profession). (Level 4) Maintains current knowledge of standards of care and practices, typically acquired through Qualifications LICENSES & CERTIFICATIONS Education: High School diploma Valid Texas Driver’s License. Preferred: Knowledge of healthcare regulations such as HIPAA, Stark Law, and Anti-Kickback Statute. TECHNICAL SKILLS Possesses advanced general skills, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a general bachelor’s degree program or associate’s degree with acquired business experience. COMPUTER Prepares more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements. Uses Microsoft Excel to create tables and simple displays of information Creates basic presentations in Microsoft PowerPoint. COMMUNICATIONS SKILLS Possesses advanced general skills, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a general bachelor's degree program or associate’s degree with acquired business experience. Physical Demands: Work is performed in a typical administrative environment. Have constant need (66% - 100% of time) for sitting. Have constant need (66% - 100% of time) for typing or writing. Have frequent need (33% - 66% of time) for driving. Have occasional need (1% - 33% of time) for standing. Have occasional need (1% - 33% of time) for walking. Have occasional need (1% - 33% of time) for reaching above shoulders. Have occasional need (l% - 33% of time) for bending, stooping, or squatting Have occasional need (1% - 33% of time for driving or operating equipment. Have rare need (less than 1% of time) for pushing or pulling. Have rare need (less than 1% of time) for climbing ladders. Have rare need (less than 1% of time) for grasping or gripping. Lifting/Carrying: Have occasional need to lift/carry 10-25 pounds. Vision Requirements: Have constant need (66% - 100% of time) to be able to see detail. Hearing Requirements: Have constant need (66% - 100% of time) to be able to hear other personnel in order to communicate effectively. Speaking Requirements: Have constant need (66% - 100% of time) to be able to hear other personnel in order to communicate effectively Environment – Working Conditions: Have constant need (66% - 100% of time) to work indoors. Have rare need (less than 1% of time) to work outdoors. Have rare need (less than 1% of time) to work in confined space. Have rare need (less than 1% of time) for exposure to fumes, chemicals, solvents, etc. Have rare need (less than 1% of time) for exposure to extreme temperatures.

Responsibilities

The Credentialing and Privileging Coordinator is responsible for coordinating the credentialing and re-credentialing process for HealthPoint clinical staff, ensuring compliance with regulations. This includes verifying qualifications, maintaining records, and collaborating with various departments.