Develops strong knowledge of the credentialing software, and full capabilities, to maximize its use and understands the functionality of the claims software, as it relates to the credentialing process.
February 11, 2020
Maintains a thorough understanding of medical staff bylaws, Joint Commission standards, hospital organization and policies, medical staff rules and regulations, national practitioner data bank regulations and procedures, credentialing and privilege delineation procedures and medico-legal issues.
January 16, 2020
Review and update departmental policies and procedures to ensure compliance with NCQA, CMS and other regulatory agencies.
January 08, 2020
Manages the processes of region-wide, complex information systems needs in project areas such as new business operating models, innovative approaches to IT solutions support, market research of emerging or available product functionality and operational readiness assessment.
January 01, 2020
Monitor Medicaid and Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation.
December 17, 2019
Assists in the development and implementation of medical record practices policies and procedures to ensure the timely, quality, and accurate delivery of medical record services.
December 13, 2019
Plans and directs program for orientation of new medical staff members to the hospital environment and duties and responsibilities of medical staff membership.
November 18, 2019
Provides day to day supervision of site-specific medical record services and staff consistent with established policy and regulatory requirements, and statutes governing health information management practices.
November 11, 2019
Manage operations for the credentialing and recredentialing process to satisfactorily meet all standards as required by HMSA policies and procedures, state and federal regulatory requirements and all relevant accreditation standards pertaining to the credentialing for HMSA providers in all lines of business including commercial, Medicare, Medicaid and ACA products.
November 03, 2019
Prepares,reviews and submits credentialing applications as determined by state, federalor accrediting agency guidelines and standards for review, recommendations anddecision by the appropriate organizational committee or body.
October 21, 2019