Company :Allegheny Health Network
Job Description :
This job coordinates, supervises and implements day to day operations within the AHN Credentialing & Privileging Office to include appointment, reappointment and ongoing verification activities of the Medical Staff and Allied Health Professional Staff. Assists management in overseeing investigation and documentation of practitioner credentials and privileges, and in utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice.
- Supervises daily activities of the teams. Review management reports to monitor workflow to ensure that providers are meeting credentialing deadlines while following regulatory standards. Audits providers records for accuracy of verifications, DOP, staff categories and dates after board approval. Participates and assists in DOH & TJC audits. (30%)
- Initiates monthly team check-ins to discuss performance and goals. Evaluates and oversees goal performance and implements improvement plans when needed. Travels to each facility to make sure departmental processes are being followed and provide guidance to staff. (20%)
- Collaborates with staff during weekly team calls keeping providers on track for targeted privileging dates. Evaluate pipeline reports identifying any providers that have a delay in the process, and assist in finding solutions for any concerns or related issues. (20%)
- Reviews and audits applications for inclusion into weekly committee agenda verifying that all providers and documents are included and approval signatures were obtained. (20%)
- Onboarding and training of new staff which includes but is not limited to identifying, interviewing and selecting qualified candidates. Maintain work hours, PTO and schedules. Approves time cards through Kronos. (10%)
- Other related duties as required.
- 3 years with physician credentialing and privileging, medical education, hospital environment, health insurance or managed care
- 1 year of coordinating, coaching and supervising or leading the work of others
- Proficiency in PC applications including Microsoft Office
- Bachelor's Degree
- Customer Service Experience
- Certified Provider Credentialing Specialist (CPCS) OR Certified Professional Medical Services Management (CPMSM)
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and trai
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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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