Job Description

Job Description

Job Description

Salary: $23.80 - $36.30

Rural Physicians Group is an expansive physician network of rural-focused hospitalist, surgicalist and APPs that are passionate about helping rural hospitals meet the needs of the communities we serve. By working with Rural Physicians Group, our hospital partners receive full-time dedicated providers on site, filling a critical void in care coverage and allowing for better patient outcomes. Better outcomes lead to expanded inpatient services. Expanded inpatient services revitalize the hospital. And a revitalized hospital improves the entire community.

RPGs mission is, Bringing rural hospitals and providers together to enhance the care of their community.

We are currently seeking a full time Licensing & Credentialing Specialist to help us with this mission.

Summary

Responsible for leading, coordinating, monitoring, and maintaining the credentialing and state licensure process. Assists with all aspects of Rural Physicians Group credentialing, including initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the contracted hospital clients Medical Staff Bylaws, policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Credentialing and the Licensing & Credentialing Coordinator.

Duties and Responsibilities

Licensing:

• Initiate the state board licensing process as assigned by completing as much of the licensing application as possible.
• Review to determine which method of application the practitioner qualifies for.
• Prepare detailed cover letters with step-by-step application instructions on how to complete and return the application, including steps to acquire supporting documents. Follow and report on required timelines and proper notifications.
• Expedite licensure application process by creating urgency via phone and email to collect relevant information in order to submit to the board and ultimately meet start date.
• Coordinate submission of all verifications required by issuing board by calling institutions listed in work and education history for accurate contact information in order to expedite on-time submittal of verification information.
• Create urgency with institutions (hospitals, universities, medical boards etc.) through follow-up calls and online resources to expedite verification completion and submission to the issuing state board.
• Follow up with issuing state board to assess licensure status and expected completion date.
• Prepare/process applications for State Controlled Substances, DEA Applications and changes and enrollments with Prescription monitoring programs as needed.
• Provide timely communication of the status of licenses in process

Credentialing

• Drafts and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Scrutinize provider applications and CVs for completion, consistency and accuracy. Quickly identify any discrepancies, gaps of employment and other challenges that could negatively impact our ability to credential a provider.
• Conducts thorough background investigation, research and primary source verification of all components of the application file by mailing, faxing, emailing or calling hospitals, licensing boards, medical schools, etc.in order to obtain verifications, references and other pertinent data from appropriate sources in a timely manner.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares applications for hospital privileges and medical malpractice insurance for completion and ensures timely and accurate submission to hospitals for each physician and allied health professional as it relates to each contracted hospital client ensuring file completion within time periods specified.
• Process, obtain and maintain malpractice insurance for each facility including verifications and claims history as required
• 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.
• Works closely with the physicians billing company and provides documentation and assistance as needed.
• Utilizes the MDStaff 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.
• Conducts compliance and sanctions monitoring. Notifying the Director of Credentialing of negative findings immediately.
• Monitors the initial and expirables process for all medical staff, Allied Health Professional staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures of contracted hospitals.
• Monitor and report on the credentialing progress of each physician.
• Work closely with contracted physicians, the hospitals Medical Staff Services department, and any 3rd party groups in order to follow up on outstanding items needed to complete files in a timely manner to ensure that we meet applicable committee meeting dates and targeted start dates.
• Respond timely to all requests from Physicians, Clients or their Medical Staff Services departments.
• Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
• High school diploma or GED; at least 4 years of experience with 2 years directly related to State Licensing, hospital medical staff and/or physician credentialing.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred.

Knowledge, Skills and Abilities Required

Possess the knowledge, as well as the following skills and abilities or be able to perform the essential functions of the job, with or without reasonable accommodation, using some other combination of knowledge, skills and abilities.

• Excellent interpersonal, written, verbal and presentation skills with the ability to communicate and discuss information in a professional and sensitive manner.
• Strong organizational, critical thinking and problem-solving skills.
• Detail oriented with solid follow up skills.
• Must be able to work in a fast-paced environment and work well under pressure.
• Program planning and implementation skills.
• Self-motivated and has ability to work independently and make independent judgements and decisions within established guidelines.
• Ability to effectively interact with internal and external employees and other outside contacts.
• Organize and prioritize workload while maintaining the ability to suddenly change what you are doing in order to meet necessary deadlines.
• Demonstrate teamwork attitude.
• 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 and make recommendations.
• Working knowledge of clinical and/or hospital operations and procedures.
• Informational research skills.
• Ability to use independent judgment to manage and impart confidential information.
• Microsoft Office skills.
• Database management skills including querying, reporting, and document generation.
• Ability to make administrative/procedural decisions and judgments.

Working Conditions and Physical Effort

• No or very limited exposure to physical risk.
• No or very limited physical effort required.
• Work is normally performed in a typical interior/office work environment.

Benefits:

• Competitive Salary
• Incentivized bonus plan
• Ability to work remotely from home
• 3 weeks PTO accrual starts your first day
• Insurance plans for medical, dental, and vision
• 401k Match
• Basic Life Insurance
• Cell Phone Allowance

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