Credentialing Specialist

Responsible for all aspects of the insurance credentialing and re-credentialing and facility licensing processes for all medical providers and facilities within Nor-Lea Hospital District. Responsible for ensuring providers and facilities are enrolled in all health plans contracted by NLHD. Maintain up-to-date data for each provider in insurance credentialing databases and online systems; ensure timely enrollment of providers and facilities in health plans and licensure of facilities.

• Coordinates provider applications; monitors applications and follows-up as needed.
• Maintains records and roster of all approved and pending providers and facilities.
• Coordinates with Human Resources to ensure seamless provider onboarding and billing of provided services.
• Maintains knowledge of current health plan contracts and agency requirements for credentialing providers. Coordinates enrollment of facilities and providers as required.
• Sets up and maintains current provider information in online credentialing database, NLHD systems and contracted vendors databases.

Values

i - Innovation

"Forward thinking" "Exploring new possibilities" "Ambitious Goals" Looks out for new and innovative approaches that will improve efficiency. Embraces and champions new ideas and encourages others to do likewise. Recognizes and rewards people and teams who are creative and innovative. This is in sharp contrast to those who tend to embrace the status quo, struggle with new approaches and discourage others when they are creative and innovative in the pursuit of increased efficiency or effectiveness.

C - Compassion

"Friendly countenance" "Servant attitude" "Demonstrating genuine concern" Shows genuine sensitivity to the needs, feelings and capabilities of other people. Deals with others in a pleasant manner. Treats others with respect and consideration. This is in contrast to those who are unpleasant and tend to alienate co-workers, or who seem insensitive to the needs of others and tend to demonstrate a lack of respect for others.

A - Accountability

"Showing integrity" "Leading by example" "Ownership and accepting responsibility" Acts in ways that demonstrate personal integrity and serves as a positive example of why others should trust the motives of the organization. Views himself or herself as a reflection of the organization by following through on commitments and accepting ownership of any mistakes he or she might make. Leaves others with the clear impression that integrity is a core value at this organization. This is in contrast to individuals who make commitments that go unmet, fail to acknowledge their role in disappointing events, or whose actions (or inaction) leave others with doubts about the level of trust that should be placed in the organization.

R - Respect

"Considerate of cultural diversity" "Building trust" "All people are to be valued" Demonstrates a genuine interest in the thoughts, opinions, values and needs of co-workers and customers. Avoids speaking, writing or doing other things that could be seen as disrespectful of people in their absence (or "behind their backs"). Recognizes and shows respect for the strengths and contributions of others. This is in clear contrast to behaviors that leave people feeling that their thoughts, opinions, values and needs are of little interest.

E - Empowerment

"Allowing others to reach their full potential: "Freedom to do what is right for our patients" "Attain and share knowledge to enrich others" Empowered in an intentional manner that allows the person to find their way, yet receiving help when needed. Using good judgment related to the level of authority given and the amount of leeway extended. This contrasts with leaders and individuals who focus more on the risks involved from the empowerment, instead of reaching the full potential of the organization.

Organization Expectations

Communication

The process of sending and receiving messages with words, verbally, written or in sign language.

Customer Focus

Identifying and responding to current and future patient and other customers’ needs; providing excellent service to internal and external patients and other customers.

Initiative

Identifying and dealing with issues proactively and persistently; seizing opportunities that arise.

Self-Development

Lifelong, voluntary, and self-motivated learning.

Teamwork

Effectively work and complete assignments in group settings. Works independently and cooperatively with others to achieve common goals.