Compliance Specialist
Solis Mammography, Addison, TX, United States
Credentialing Specialist
At Solis Mammography, we save lives. We shape the future of women's health. We are empowered, appreciated, and part of something bigger. Together, we deliver compassionate, exceptional care. Every patient. Every time.
Our patient-focused culture is at the heart of every interaction. We deliver the care, compassion and high-touch experience that have made us a valued healthcare partner to the generations of women that we serve. As the nation's leader in breast health services, our commitment to providing excellence in patient care is realized at every level of our organization.
Looking to elevate your career? Join us!
Work Location: Remote
Work Hours: Full-Time, 40 hours per week
A Day in the Life of a Credentialing Specialist Manages a database of certifications, credentials, and continuing education and requirements for Radiologists reading images according to MQSA and ACR standards. Plan, organize and coordinate credentialing activities. Communicate with payors to ensure that physicians are on contracts.
Results Measured By The Following Responsibilities
Resolves credentialing issues through proactive measures and follow through.
Researches and verifies on engagement, the competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, health care affiliations, work history, military experiences, professional references, licensure and certifications, DEA certificates, malpractice coverage and privileges the applicant is requesting according to MQSA requirements
Confirms in the OIG database, queries the National Practitioner Data Bank at start of engagement
Ensures process of attestation is in place after Queries the Counsel for Affordable Healthcare (CAQH) database at the start of engagement, and manages expiring documents as appropriate
Serves as the sole Manager for the credentialing database assuring accuracy and completeness
Acts as a liaison between the various Radiology Groups and Solis (and its affiliates) to provides assistance in the coordination of the credentialing dates and times for new placements
Facilitate physician onboarding with Manager of Clinical Training.
Establishes a working knowledge of the regulatory MQSA and ACR requirements, compliance standards, State and Federal Law pertaining to the Radiologists and apply them to the credentialing process as needed
Perform OIG Exclusion checks on all Radiologists, Vendors and Referring physicians monthly
Create and maintain relationships with Medical Director, physician groups, center directors, regional operations directors and VPs of Operations.
Manages compliance requirements through maintaining MQSA and ACR Certifications for all center locations
Manages compliance requirements through maintaining insurance documents for all center locations and distribute to center directors
Distribute MQSA and ACR notices to Director of Quality for follow up and assist in coordinating the effort for investigation
Liaison with Billing company to ensure that Radiologists are contracted with various payors
Liaison with Billing company to provide update, legal names, demographic information and national provider numbers for all joint ventures to ensure that they are amended on billing contracts.
Upholds HIPAA regulations
Other related responsibilities as required
Understands, promotes and demonstrates the Solis Way
Here Is What You Will Need
Bachelor's degree or equivalent experience preferred.
Two or more years of credentialing experience working with NCQA standards.
Minimum of two years of experience in a centralized credentialing office or related health care environment, such as credentialing or file maintenance, preferred with experience in Word and Excel.
At least two years of data entry experience.
Working knowledge of managed care and/or credentialing.
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Our patient-focused culture is at the heart of every interaction. We deliver the care, compassion and high-touch experience that have made us a valued healthcare partner to the generations of women that we serve. As the nation's leader in breast health services, our commitment to providing excellence in patient care is realized at every level of our organization.
Looking to elevate your career? Join us!
Work Location: Remote
Work Hours: Full-Time, 40 hours per week
A Day in the Life of a Credentialing Specialist Manages a database of certifications, credentials, and continuing education and requirements for Radiologists reading images according to MQSA and ACR standards. Plan, organize and coordinate credentialing activities. Communicate with payors to ensure that physicians are on contracts.
Results Measured By The Following Responsibilities
Resolves credentialing issues through proactive measures and follow through.
Researches and verifies on engagement, the competence, medical and/or professional education, residency, internships, fellowships, additional formal training, relevant board certifications, health care affiliations, work history, military experiences, professional references, licensure and certifications, DEA certificates, malpractice coverage and privileges the applicant is requesting according to MQSA requirements
Confirms in the OIG database, queries the National Practitioner Data Bank at start of engagement
Ensures process of attestation is in place after Queries the Counsel for Affordable Healthcare (CAQH) database at the start of engagement, and manages expiring documents as appropriate
Serves as the sole Manager for the credentialing database assuring accuracy and completeness
Acts as a liaison between the various Radiology Groups and Solis (and its affiliates) to provides assistance in the coordination of the credentialing dates and times for new placements
Facilitate physician onboarding with Manager of Clinical Training.
Establishes a working knowledge of the regulatory MQSA and ACR requirements, compliance standards, State and Federal Law pertaining to the Radiologists and apply them to the credentialing process as needed
Perform OIG Exclusion checks on all Radiologists, Vendors and Referring physicians monthly
Create and maintain relationships with Medical Director, physician groups, center directors, regional operations directors and VPs of Operations.
Manages compliance requirements through maintaining MQSA and ACR Certifications for all center locations
Manages compliance requirements through maintaining insurance documents for all center locations and distribute to center directors
Distribute MQSA and ACR notices to Director of Quality for follow up and assist in coordinating the effort for investigation
Liaison with Billing company to ensure that Radiologists are contracted with various payors
Liaison with Billing company to provide update, legal names, demographic information and national provider numbers for all joint ventures to ensure that they are amended on billing contracts.
Upholds HIPAA regulations
Other related responsibilities as required
Understands, promotes and demonstrates the Solis Way
Here Is What You Will Need
Bachelor's degree or equivalent experience preferred.
Two or more years of credentialing experience working with NCQA standards.
Minimum of two years of experience in a centralized credentialing office or related health care environment, such as credentialing or file maintenance, preferred with experience in Word and Excel.
At least two years of data entry experience.
Working knowledge of managed care and/or credentialing.
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