Job Summary: Provides administrative assistant support to the Credentialing Coordinator.
Essential Duties and Responsibilities:
Assist with the coordination of PCC credentialing process for medical, dental and behavioral health providers.
Meets with candidates to gather appropriate documentation, ensuring completeness and accuracy.
Follow-up with candidates to ensure all documents are completed in a timely manner.
Double checks CVO verifications.
Assist with the PCC privileging process for medical, dental and behavioral health providers.
Distributes and collects privileging applications from candidates.
Coordinates and Maintains the PCC re-credentialing process for medical, dental and behavioral health providers.
Ensures re-credentialing and privileging occur within proscribed timeline.
Distributes and collects peer evaluations.
Assist with the termination process of all PCC providers that will be terming employment from the organization
Assist with the gathering and submission of all necessary documentation to ensure the credentialing for Medicaid, Medicare, commercial insurers and managed care plans for medical, dental and behavioral health providers.
Verifies credentialing is completed.
Ensures such credentials are updated as needed.
Alerts Credentialing Coordinator with any interruptions that may cause or has caused a provider to obtain an inactive credentialing status with Medicaid, Medicare, or any of the commercial insurers
Maintain the Council For Affordable Quality Healthcare (CAQH) database for all PCC providers
Maintain the provider information spreadsheets for tracking a provider’s status, such as the credentialing spreadsheet, provider’s license spreadsheet, etc.
Gathers and submits all necessary documentation to ensure credentialing and privileging with hospitals for medical providers.
Ensures such credentials and privileges are updated as needed.
Track expiration date of provider licenses and certifications; notify providers of upcoming expiration; and facilitate renewal.
This includes medical licenses, prescription licenses and specialty Board certification.
Ensure that all licensed independent practitioners maintain active licensure.
Maintain knowledge of Joint Commission standards and state and federal regulations with regard to provider credentialing and privileging.
Attend training sessions and conferences as needed to maintain this knowledge.
Maintain records of credentialing and privileging for PCC providers.
Responsible for making sure that all EHR credentialing provider enrollment and claims worklist tasks and personal buckets are monitored and completed in a timely fashion.
All other duties as assigned.
High school diploma or G.E.D. is required.
Associate Degree is preferred.
One plus years’ experience as an administrative assistant is required.
One plus years’ experience with credentialing in a healthcare setting is preferred.
One plus years’ experience handling various types of insurances relating to Medicare, Medicaid, Managed Care, and Commercials is preferred.
Familiar with Joint Commission and NCQA accreditation is preferred.
Must be able to remain in a stationary position 50% of the time.
Must be able to move around the clinic site 50% of the time.
Constantly operates a computer, computer printer, copy machine, and telephone.
Occasionally positions self to maintain exertion of physical strength to move objects of 10 pounds from one level to another.
Must be able to transport from one site to another.
Must be able to cover other shifts as necessary.
Ability to read and write proficiently using the English language.
Proficient in MS Office Business Applications to include: Outlook, Word, PowerPoint, and Excel.
Excellent business writing skills.
Ability to function independently, work under pressure, and prioritize multiple projects.
Ability to establish and maintain effective working relationships with supervisors, senior management staff, medical staff, co-workers, community leaders and the general public. Must be able to exchange accurate information in these situations.
Additional Salary Information: Compensatory with experience.
The mission of PCC is to improve health outcomes for the medically underserved community through the provision of high quality, affordable, and accessible primary health care and support services. Anchored with family medicine, we are committed to serving the needs of all people in all stages of life, while we continue to specialize in the delivery of comprehensive maternal and child health servic...es to address this unmet need in our community.
PCC prides itself in providing a model work environment. PCC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.
For more information on PCC Community Wellness, please visit our Web site at http://www.pccwellness.org