HR Tech - Ortho Credentialing

at  University of New Mexico

POSITION SUMMARY

Provides specialized operational and administrative support to a centralized human resources specialty activity, such as employment, compensation, labor relations, benefits, or training and development. Provides day-to-day advice, assistance, and follow-up to client departments, employees, external agencies, and/or members of the general public in the application of specified policies, procedures, and documentation. Coordinates the resolution and/or referral of specific policy-related and procedural problems and inquiries. Develops, expedites, and maintains files, records, and other documents.
Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards. Conducts primary source verification, collects and validates documents to ensure accuracy of credentialing of elements; assesses completeness of information and qualifications relative to credentialing standards and UNM Health System criteria.. Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to CVO credentialing Manager and entity Medical Staff Affairs for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency. Monitors files to ensure completeness and accuracy; reviews all file requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate. Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures. Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines. Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards. Communicates clearly with providers, their liaisons, entity Medical Staff Affairs. medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry. Performs miscellaneous job-related duties as assigned.
See the Position Description for additional information.

MINIMUM QUALIFICATIONS

High school diploma or GED; at least 3 years of experience directly related to the duties and responsibilities specified.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

PREFERRED QUALIFICATIONS

• Degree Preferred
• Experience with UNM Credentialing
• Familiar with UNM CVO processes

Please refer the Job description for details