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.
September 07, 2022
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.
October 31, 2022
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.
November 22, 2022
Monitor Medicaid and Medicare sanctioning reports to ensure compliance with Health Care Financing Administration (HCFA) requirements regarding prohibition of excluded provider participation.
January 15, 2023
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.
February 02, 2023
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.
March 23, 2023
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.
April 03, 2023
Review and update departmental policies and procedures to ensure compliance with NCQA, CMS and other regulatory agencies.
April 26, 2023
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.
May 10, 2023
Plans and directs program for orientation of new medical staff members to the hospital environment and duties and responsibilities of medical staff membership.
May 19, 2023
