Credentialing Specialist

About this role

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description: The  Credenti aling Specialist  will report to  OneOncology’s   Credentialing Supervisor .   The credentialing specialist   is responsible for   all aspects of the   privileging   and credentialing process for physicians and allied health professionals. The Specialist will process applications, verify information, research application details, and   assure   processes are   in accordance with   medial   staff procedures. The specialists will provide consistent,   accurate , and   timely   credentialing support, enhancing the   organization’s   ability to provide professional services. Work includes the   accurate ,   timely   and documented verification of the information provided by the application and maintenance of the highly confidential credentialing related files .     

Responsibilities  

• Credentialing and re-credentialing of physicians and   advanced practice providers.  

• Completion, submission and tracking of credentialing applications with all managed care organizations and hospitals.   

• Apply   for   and   validate   hospital privileges .  

• Obtain malpractice insurance policy .  

• Notification to staff   of   completion of credentialing for scheduling and billing .  

• Maintain and update CAQH online credentialing   application   for all providers quarterly. Database management/provider files .  

• Maintain vital provider credentialing information via technology tool and hard copies of documents in provider files stored on   OneOncology   platform.   

• Tracking and   maintaining   all clinical licenses for nursing, pharmacy, and lab personnel .  

• Provider continuing education  

• Track continuing education credits for all providers .  

• Notify providers of any deficiencies .  

• Submit documentation if providers are audited .  

• Termination of physician and/or allied health professional .  

• Contact all MCO/hospitals/EMR to remove   provider   who   has   left practice, within   30 days   of termination.   

• Other tasks as assigned to drive our mission of improving the lives of everyone living with cancer.   

Key Competencies  

• Experience working with NCQA criteria and   third-party   payer regulations.  

• Experience with   completing hospital credentialing applications.  

• Proficient with MS Office Suite (word, excel) and   web-based   applications .  

• Ability to   maintain   verbal and   written communications   in a confiden tial manner .  

• Detail   oriented with strong organizational skills .  

• Excellent interpersonal skills – team   player   who   can   prioritize multiple responsibilities, manage a large workload within tight deadlines – works well under pressure and consistently meets deadlines, readily adapts to   change,   and excels in a   productivity-based   environment .  

• Demonstrates research and problem-solving skills .  

Qualifications  

• Current working knowledge of enrollment processes with California   payors , Commercial and Government.  

• High school diploma and 2+ years of related experience .   

• Bachelor’s degree preferred.   

• Industry experience   leading credentialing activities   in   large provider   practice   (or multiple practices )   is   required .  

• Certifications   preferred   but not   required .  

• Working remote   with   Travel flexibility   as needed.   

• Working Pacific Standard Time hours.  

#LI-REMOTE

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