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Posted By Administrator
- April-11-2007
- 6:55am
- 0 comments
- Edit
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Location: Boston
Grade: 10
FLSA Status: Exempt
Department: Office of Clinical Affairs
Reports To: Credentialing Manager
Recruiter: Charles Curti
Referral Bonus:
Job Summary:
The Facility Credentialing Coordinator is responsible for the Credentialing process for all facilities in the BMCHP network, including Acute Care Hospitals, Extended Care Facilities, Home Care Agencies, and Surgical Facilities, and all behavioral health facilities.
Key Functions:
• Processes initial and re-credentialing applications for all facilities‚ collecting and verifying data‚ communicating with personnel at facilities‚ following up on clinical concerns‚ and processing quality data.
• Collaborates with Contracting and Clinical Affairs staff‚ and is responsible for maintaining compliance with NCQA and Mass Health requirements.
• Develops implements and monitors work schedules to assure compliance with credentialing cycles and turnaround times.
• Serves as primary contact for NCQA site surveys regarding Facility Credentialing for BMCHP.
• Assures data collection and verification of information critical to the credentialing process. Prepares and reviews complete files.
• Prepares reports to document Compliance with re-credentialing standards.
• Responsible for final recommendation to clinical reviewers prior to decision. Schedules and meets with internal clinical reviewers to review files. Forwards clean list to Medical Director for approval.
• Responsible for staff support to the monthly Credentialing Committee meeting for facility files. Prepares material for the meeting‚ and handles follow up letters to facilities. Establishes relationships with internal customers and ensures appropriate coordination of program documentation including applications and credentialing approval dates.
• Participates in development of Facility Credentialing Policies and processes.
• Assesses need for site visits to facilities based on Committee recommendations and as a result of available quality data from a variety of sources. Plans and communicates the visit internally and externally. Communicates with Clinical Affairs‚ Care Management and Contracting staff to assure complete information regarding usage and experience with the facility is available. Provides survey tool‚ conducts the site visit‚ and gathers input for final assessment.
Qualifications:
• Bachelor’s Degree in Healthcare Administration‚ related field‚ or an equivalent combination of education‚ training and experience is required
• A minimum of two (2) years of progressively responsible credentialing experience required.
• Excellent oral and written communication skills required.
• Ability to provide high quality customer service.
• Experience with standard Microsoft Office applications (Outlook‚ Word‚ Excel‚ PowerPoint) is required.
• Comprehensive knowledge and experience with Cactus credentialing database required.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required.
• No or very limited exposure to physical risk.
Please have applicant send resume and cover letter to:
Email: jobs@bmchp.org
Mail: Human Resources
BMC HealthNet Plan
Two Copley Place
Suite 600
Boston, MA 02116
Fax: (617) 748-6152
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