Analysis Skills, Banking Services, Behavioral Health, Billing, Communication Skills, Credit and Collections, Customer Support/Service, Data Quality, Documentation, Federal Laws and Regulations, Flexible Spending Accounts, Health Information Management, Healthcare, Healthcare Providers, Hospital, Identify Issues, Legal, Litigation, Maintain Compliance, Management Strategy, Medicaid, Medical Billing, National Committee for Quality Assurance (NCQA), Policy Development, Policy Implementation, Prescription Drugs, Problem Solving Skills, Record Keeping, Regulations, Revenue Management, Risk, Risk Analysis, State Laws and Regulations, Stock Purchase Plans, Strategic Planning, Team Player, Telemedicine, Time Management
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Credentialing Specialist II with Parallon you can be a part of an organization that is devoted to giving back!
Job Summary and Qualifications
The Credentialing Processing Center Specialist II is responsible for safeguarding the patient well-being and elevating clinical excellence across our healthcare enterprise by meticulously ensuring hospitals and other healthcare facilities possess comprehensive, verified practitioner legally required credentials. This role is pivotal in empowering informed decisions regarding practitioner access, directly impacting the thousands of lives under our care daily.
- Mastery communication and regulatory guidelines, policies, procedures, and internal systems, coupled with keen insight into practitioner 350+ internal customers, plus external customers.
- Forges collaborative partnerships with over 350+ healthcare facilities, customers, and stakeholders.
- Mastered competency and acquired extensive experience through review of Data Integrity Reviews, Specialist Reviews, and Compliance Reviews, that supports precise accurate identification of potential practitioner issues and flagging of practitioner risk.
- Adheres to stringent regulatory guidelines, Joint Commission Standards, Facility Bylaws and CPC standards.
- Ensures the flawless, timely, and accurate credentialing of medical and allied healthcare providers, upholding the highest standards of quality
- Mastered through experience and exposure to complex credentialing documents and verifications the competency to discern, identify and escalate practitioner risk concerns by utilizing the policies, procedures, verification elements, or regulatory guidelines as validation. In addition, competency, and experience that supports the identification of potential risk outside of policy requirements.
- Orchestrates the comprehensive collection of all pertinent information, strategically managing follow-up for missing or incomplete documentation through effective communication and relationship building with practitioners and other external organizations.
- Identifies and analyzes potential compliance flags and master the skill set through experience to collaborate with practitioners on sensitive issues and other external organization, such as drug addiction centers or anger management centers, to accurate document or resolve sensitive and confidential practitioner issues.
- Mastered the ability to meticulously document resolution and/or unresolved complex issues and escalations as needed in practitioner files that may support future lawsuits.
- Possesses expertise knowledge to contribute valuable insight into the strategic development and implementation of policy frameworks, and participates in comprehensive audits, ensuring regulatory adherence.
- Provides strategic counsel to Managers and Directors regarding ambiguous information, and escalates critical issues identified during credentialing processes with expediency and precision.
- Maintains meticulous credentialing records, guaranteeing the accurate scanning and secure storage of all correspondence within mandated timeframes.
- Upholds unwavering compliance with all governing policies, procedures, and Federal and State regulatory and accrediting agency requirements.
- Associate’s degree or equivalent work experience. Bachelor’s degree preferred
- 5+ years’ experience in healthcare credentialling with Parallon or HCA required
- Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance, preferred.
- Detailed working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
- NAMSS Certification preferred.
- Remote employees are required to live within 60 miles of an HCA hospital
- Remote employees are required to have wired (Cable or fiber) internet access with 25 MBS Download and 15 MBS Upload.
Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- Wellbeing support, including free counseling and referral services
- Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
- Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
- Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
- Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
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Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
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"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Credentialing Specialist II opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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HCA Healthcare
At its founding in 1968, Nashville-based HCA was one of the nation's first hospital companies. Today, we are the nation's leading provider of healthcare services, a company comprised of locally managed facilities that includes about 165 hospitals and 115 freestanding surgery centers in 20 states and England and employing approximately 204,000 people. Approximately four to five percent of all inpatient care delivered in the country today is provided by HCA facilities. Richard M. Bracken serves as Chairman of HCA and R. Milton Johnson is the company's President and Chief Executive Officer.
HCA is committed to the care and improvement of human life and strives to deliver high quality, cost effective healthcare in the communities we serve. Building on the foundation provided by our Mission & Values, HCA puts patients first and works to constantly improve the care we give them by implementing measures that support our caregivers, help ensure patient safety and provide the highest possible quality. Investing in our communities is important to us. HCA typically invests about $1.5 billion annually to keep our facilities modern and up-to-date technologically and to expand and add services where needed. Focusing primarily on communities where the company is a leading healthcare provider, HCA selectively adds new facilities in order to better serve our communities.
And because two HCA founders were physicians, we value highly the strong relationships we've created with local physicians. We endeavor to provide them with a wide array of services and modern facilities in order to help them deliver the best possible care.