Medical Staff Services-Credentialing

Job Summary

WELLBE INTRODUCTION

The WellBe care model is a Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients.  This population is typically underserved and very challenged with access to care.   To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care.  WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

Job Description

OBJECTIVES

The Credentialing Specialist is a critical member of the Credentialing team, assisting in the onboarding credentialing, and enrollment of all WellBe Providers.   The successful candidate should be detail oriented, with excellent communication skills and experience working in health plan credentialing.

GENERAL SUMMARY

• Own the end-to-end credentialing process for WellBe providers, helping meet and improve turn-around timelines for provider credentialing
• Renew expiring documents and certification on behalf of and in cooperation with clinical staff
• Communicate with care providers about impending expirations and requirements for renewal Facilitate payment for application and renewal fees according to Accounting guidelines
• Obtain primary source verification when indicated
• Coordinate with Human Resources to ensure provider’s successful preboarding post-offer
• Maintain credentialing database including CAQH and WellBe Credentialing system profiles with attention to detail and assist providers with data entry
• Coordinate with CVO with any incomplete credentialing packets
• Coordinate any form completions needed for hospital privileging
• Prepare and participate in health plan audits as needed
• Observe WellBe Senior Medical Group’s policies and procedures, client contract requirements, state guidelines, and NCQA standards when credentialing providers
• Responsible for all credentialing file additions, changes, and deletions between renewals, including but not limited to address changes and personal information updates
• Facilitate malpractice insurance applications and certificate updates
• Review the ongoing monitoring reports, follow up with clinicians, and review potential matches with direct supervisor and Credentialing Chair for all states
• Facilitate any Collaborating agreement completions and submissions as indicated by state regulations

• Update and submit provider rosters on a monthly basis for every health plan
• Participate and support the organization of WellBe Credentialing Committee and weekly check-in meetings as needed
• Conduct pre-credentialing screenings for new provider hires within a timely manner
• Coordinating and validating chart reviews between the supervising physician and nurse practitioner
• Other administrative duties as determined

Job Requirements

SKILLS & COMPETENCIES

To perform the job successfully, an individual should demonstrate the following competencies:

• Excellent detail orientation and organizational skills
• Ability to maintain confidentiality
• Strong written and verbal communication skills
• Effective interpersonal skills
• Advanced Windows-based computer skills

QUALIFICATIONS

Educational/Experience Requirements

• High school graduate or equivalent
• 3 years credentialing or related experience required

Required Skills and Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibility: No Supervisory responsibilities. 

Travel Requirements: No travel is required for this position

Work Conditions: Ability to lift up to 20lbs.  Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. 

• Ability to stand for extended periods
• Ability to drive to patient locations (ie. home, hospital, SNF, etc)
• Fine motor skills
• Visual acuity

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification.  Management reserves the right to add, modify, change or rescind the work assignments of this position.  Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.