HP Credentialing - CME Spec

Where compassion meets innovation and technology and our employees are family.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.

• Maintains utmost level of confidentiality at all times.
• Adheres to DHS/DHP policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. 
• Processes applications for credentialing and recredentialing.
• Processes requests for temporary privileges.
• Prepares confidential correspondence.
• Oversees and maintains the credentialing database program.
• Maintains all credentials files.
• Prepares credentialing profiles.
• Monitors database for expiration of required credentials, securing current verification of licensure, DEA, and professional liability insurance.
• Monitors state and federal sanctions reports.
• Oversight of all provider data to be published in provider directories and GeoAccess prepared provider maps.

• Other duties as needed to support business operations.

Education and/or Experience:

• High school diploma or general education degree (GED); or three to five years related experience and/or training; or equivalent combination of education and experience.

• Credentialing and/or Health Plan/HMO experience is preferred.