Provider Relations Privileging and Licensing Specialist
Nevada Health Centers, Las Vegas, Nevada, us, 89105
Supports all aspects of provider relations with clinical staff in a non-profit health care setting for designated business unit(s). This position is hybrid so employees are required to live in the State of NV. This position can be accommodated in Northern NV (Carson City), or Southern NV (Las Vegas).
Essential Duties and Responsibilities
Manages credentialing and Medicare/Medicaid revalidations for NVHC health clinic locations Manages and maintains all credentialing and privileging files for non-provider clinical staff as required by Health Resource and Service Administration (HRSA). Responsible for the compliance of all OCLP and OCS credentialing files Working in partnership with Human Resources: Monitors for new clinical hires, Partners with Human Resources for gathering of required paperwork and information for credentialing files, Partners with Human Resources for ongoing credentialing paperwork needs Manages queries of state and national websites for new clinical staff to verify eligibility for employment, licenses, certifications, and/or registration Manages queries of national websites to ensure that NPDB and OIG queries are completed and reviewed prior to employment of clinical staff, reports any findings to the Provider Relations manager in a timely fashion Maintains knowledge of HRSA regulations and changes in compliance Manages new PINs and PALs and reports any updates to Provider Relations team Monitors licensure end dates and informs clinical staff of need for renewals Monitors new hires for training completion and ensures that training documentation is complete, signed, and part of the employee’s credentialing file Works with clinical leadership to obtain documentation of competency and fitness for duty Prepares credentialing files for initial privileging Manages reappointment processes, monitors expiration dates and ensures that reappointments are completed in a timely manner Works with clinical staff members to request necessary documentation and to compile reappointment requests Answers staff questions related to credentialing and privileging Assists with management of CME requests and tracking of CME costs and requirements and assists with enrollments into requested CME courses Assists with the purchase and tracking of provider subscriptions and memberships Manages the student process and onboarding/offboarding of students in structured shadowing programs Assists with management of enrollments for LIP as requested Provides feedback on processes and participates in process improvement within the Provider Relations team Performs other work-related duties as requested by supervisor Complies with all aspects of the Standards of Behavior Supports the Provider Relations team as needed Required Qualifications
Minimum of 3 to 5 years of credentialing and privileging experience or similar relevant experience Preferred Qualifications
Working knowledge of Microsoft Word, Excel and PowerPoint Working knowledge of DocuSign Working knowledge of basic computer file systems, naming conventions, and organization Ability to take direction and be well organized Ability to communicate in a courteous and professional manner Ability to work and interact effectively and positively with other staff members to build and to enhance teamwork in the clinics and overall NVHC organization Skill in communicating effectively, both in oral and written form, to individuals and groups Skill in accuracy and attention to detail Ability to maintain confidentiality of information Ability to solve practical problems and deal with a variety of variables Ability to understand and respond appropriately, effectively, and sensitively to special population groups as defined by race, ethnicity, language, age, sex, etc. Ability to work and interact effectively and positively with all levels of staff to build and enhance teamwork in the clinics and in the overall NVHC organization Ability to address multiple priorities; manage time and complete work in a timely and accurate manner while under the pressure of meeting deadlines Ability to handle stressful situations appropriately Ability to work independently Problem solving Ability to come to logical conclusions Ability to work proactively and identify issues before they become problematic Demonstrated ability to maintain confidentiality Flexible to handle unexpected daily challenges Knowledge of credentialing and privileging rules and regulations Knowledge of Medicare, Medicaid, and private insurance Knowledge of basic healthcare compliance fundamentals Knowledge of basic medical practices and terminology Represents organization in a positive and professional manner Equal Opportunity Statement
Nevada Health Centers will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation, gender identity and expression or any other category protected by law. Americans with Disabilities Act (ADA) Statement
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds. Job Description is a Guideline Only
This job description is a summary of the main functions and responsibilities of this position as it currently exists. It is not intended to be a complete and exhaustive list or description and may evolve and change over time in accordance with business and market demands. This job description is also not a contract, and Nevada Health Centers may from time-to-time in its discretion revise, amend, and update this job description.
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Manages credentialing and Medicare/Medicaid revalidations for NVHC health clinic locations Manages and maintains all credentialing and privileging files for non-provider clinical staff as required by Health Resource and Service Administration (HRSA). Responsible for the compliance of all OCLP and OCS credentialing files Working in partnership with Human Resources: Monitors for new clinical hires, Partners with Human Resources for gathering of required paperwork and information for credentialing files, Partners with Human Resources for ongoing credentialing paperwork needs Manages queries of state and national websites for new clinical staff to verify eligibility for employment, licenses, certifications, and/or registration Manages queries of national websites to ensure that NPDB and OIG queries are completed and reviewed prior to employment of clinical staff, reports any findings to the Provider Relations manager in a timely fashion Maintains knowledge of HRSA regulations and changes in compliance Manages new PINs and PALs and reports any updates to Provider Relations team Monitors licensure end dates and informs clinical staff of need for renewals Monitors new hires for training completion and ensures that training documentation is complete, signed, and part of the employee’s credentialing file Works with clinical leadership to obtain documentation of competency and fitness for duty Prepares credentialing files for initial privileging Manages reappointment processes, monitors expiration dates and ensures that reappointments are completed in a timely manner Works with clinical staff members to request necessary documentation and to compile reappointment requests Answers staff questions related to credentialing and privileging Assists with management of CME requests and tracking of CME costs and requirements and assists with enrollments into requested CME courses Assists with the purchase and tracking of provider subscriptions and memberships Manages the student process and onboarding/offboarding of students in structured shadowing programs Assists with management of enrollments for LIP as requested Provides feedback on processes and participates in process improvement within the Provider Relations team Performs other work-related duties as requested by supervisor Complies with all aspects of the Standards of Behavior Supports the Provider Relations team as needed Required Qualifications
Minimum of 3 to 5 years of credentialing and privileging experience or similar relevant experience Preferred Qualifications
Working knowledge of Microsoft Word, Excel and PowerPoint Working knowledge of DocuSign Working knowledge of basic computer file systems, naming conventions, and organization Ability to take direction and be well organized Ability to communicate in a courteous and professional manner Ability to work and interact effectively and positively with other staff members to build and to enhance teamwork in the clinics and overall NVHC organization Skill in communicating effectively, both in oral and written form, to individuals and groups Skill in accuracy and attention to detail Ability to maintain confidentiality of information Ability to solve practical problems and deal with a variety of variables Ability to understand and respond appropriately, effectively, and sensitively to special population groups as defined by race, ethnicity, language, age, sex, etc. Ability to work and interact effectively and positively with all levels of staff to build and enhance teamwork in the clinics and in the overall NVHC organization Ability to address multiple priorities; manage time and complete work in a timely and accurate manner while under the pressure of meeting deadlines Ability to handle stressful situations appropriately Ability to work independently Problem solving Ability to come to logical conclusions Ability to work proactively and identify issues before they become problematic Demonstrated ability to maintain confidentiality Flexible to handle unexpected daily challenges Knowledge of credentialing and privileging rules and regulations Knowledge of Medicare, Medicaid, and private insurance Knowledge of basic healthcare compliance fundamentals Knowledge of basic medical practices and terminology Represents organization in a positive and professional manner Equal Opportunity Statement
Nevada Health Centers will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation, gender identity and expression or any other category protected by law. Americans with Disabilities Act (ADA) Statement
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds. Job Description is a Guideline Only
This job description is a summary of the main functions and responsibilities of this position as it currently exists. It is not intended to be a complete and exhaustive list or description and may evolve and change over time in accordance with business and market demands. This job description is also not a contract, and Nevada Health Centers may from time-to-time in its discretion revise, amend, and update this job description.
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