Academy of Managed Care Pharmacy
Credentialing Specialist Managed Care
Academy of Managed Care Pharmacy, Florida, New York, United States
Benefits and Perks
All the benefits and perks you need for you and your family:
Benefits from Day One
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support
Our Promise Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift and Location Shift: Monday- Friday Full time 8am-5pm
Job Location: Remote
The Role You Will Contribute Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Adventist Health Systems (AHS) credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Value to the Team
Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Conducts thorough background investigation, research and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.
Achieves productivity standards as determined by management.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.
Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
Assists with managed care delegated credentialing audits; conducts internal file audits.
Utilizes the MSOW/Apogee credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Monitors the initial, reappointment and expirables process for all AHS employed physicians, allied health professional staff, other health professional staff, delegated and community CIN providers affiliated with AHS. Responsible for ensuring compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.
Performs miscellaneous job-related duties as assigned.
Qualifications You'll Need High School Grad or Equiv
Attentive to detail and accuracy; strong organization skills required.
Ability to communicate effectively, both orally and in writing.
Program planning and implementation skills.
Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing and privileging procedures and standards.
Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
Working knowledge of clinical and/or hospital operations and procedures.
Informational research skills.
Ability to use independent judgment to manage and impart confidential information.
Database management skills including querying, reporting, and document generation.
Ability to make administrative/procedural decisions and judgments.
Certified Professional Medical Staff Management (CPMSM) Preferred Or
Certified Provider Credentialing Specialist (CPCS) Preferred
Additional Licenses and Certifications actively pursuing certification by NAMSS Certification
Preferred Qualifications MSOW/Apogee
Typing 35 wpm
MS Office (Excel, Word, Outlook)
Equal Opportunity Statement This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
Category Managed Care
Organization AdventHealth Corporate
Schedule Full-time
Shift Day
#J-18808-Ljbffr
Benefits from Day One
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support
Our Promise Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift and Location Shift: Monday- Friday Full time 8am-5pm
Job Location: Remote
The Role You Will Contribute Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Adventist Health Systems (AHS) credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Value to the Team
Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Conducts thorough background investigation, research and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.
Achieves productivity standards as determined by management.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.
Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
Assists with managed care delegated credentialing audits; conducts internal file audits.
Utilizes the MSOW/Apogee credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Monitors the initial, reappointment and expirables process for all AHS employed physicians, allied health professional staff, other health professional staff, delegated and community CIN providers affiliated with AHS. Responsible for ensuring compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.
Performs miscellaneous job-related duties as assigned.
Qualifications You'll Need High School Grad or Equiv
Attentive to detail and accuracy; strong organization skills required.
Ability to communicate effectively, both orally and in writing.
Program planning and implementation skills.
Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing and privileging procedures and standards.
Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
Working knowledge of clinical and/or hospital operations and procedures.
Informational research skills.
Ability to use independent judgment to manage and impart confidential information.
Database management skills including querying, reporting, and document generation.
Ability to make administrative/procedural decisions and judgments.
Certified Professional Medical Staff Management (CPMSM) Preferred Or
Certified Provider Credentialing Specialist (CPCS) Preferred
Additional Licenses and Certifications actively pursuing certification by NAMSS Certification
Preferred Qualifications MSOW/Apogee
Typing 35 wpm
MS Office (Excel, Word, Outlook)
Equal Opportunity Statement This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
Category Managed Care
Organization AdventHealth Corporate
Schedule Full-time
Shift Day
#J-18808-Ljbffr