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Clinical Documentation & Credentialing Spc.

Location: Chicago
Posted on: March 20, 2023

Job Description:

Job Title:Clinical Documentation and Credentialing SpecialistSupervisory Role:NoExemption Status:Non-ExemptDate Created/Revised:March 17, 2023 JOB SUMMARY The Clinical Documentation and Credentialing Specialist will assist Elite's Legal Team to ensure we collect and verify all required documentation from new or rehired clinicians before they begin or resume treating patients at our practices. This team member will have direct and consistent communication with providers throughout the offer, hiring and onboarding process to facilitate and ensure compliance with Elite Dental Partners' documentation requirements. The documents will be securely stored and updated as expiration dates approach. The Clinical Documentation and Credentialing Specialist will be responsible for collection of all required documents and information, including the items listed below and any other documentation which is deemed necessary. Required Documentation (dentist and/or hygienist)Required Information and VerificationDental or Hygiene License (& licenses in other states)DiplomaCV (current/updated)DEA Certificate CDS (State Controlled Dangerous Substance)CPR & BLSAnesthesia License *Nitrous Certification (per state) *Specialty Certificate *Residency Certification & Information *Board Certification *Malpractice Coverage Sheet (from Compliance Dept)Malpractice/Dental License Narrative *Name Change Information *Work Gap History & Explanation * Background check (history and criminal - coordinate with recruiting department if this is already being run)NPDB (healthcare-specific background check)SAMS (Medicare/Medicaid conflicts)OIG (Fraud, Waste & Abuse Violations)Type 1 Provider NPI (confirmed on NPPS database and matching name on dental license)CAQH Provider Acknowledgement form, updated CAQH Profile & related informationProvider Digital Signature (in Credentialing/Compliance software)* If applicable Documentation must be verified through the proper channels; as well as checked for accuracy and legibility. A copy of the actual document must be obtained for Elite's files. The Clinical Documentation and Credentialing Specialist will need to maintain familiarity with the documents and information and become a resource to explain what is needed and answer clinicians' questions throughout the process. A candidate with a working knowledge of regulatory compliance standards including: OSHA, CDC, HIPAA, EPA, FDA and all Federal and State standards applicable to the dental setting would be a good fit for this role. This position reports directly to the General Counsel or Vice President of Payor Contracting and works in close partnership with our doctors and hygienists; as well as the legal, compliance and insurance credentialing teams. To perform this job successfully, an individual must be able to perform each of the essential job duties satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. ESSENTIAL JOB RESPONSIBILITIESEnsure Elite Dental Partners' required documentation is collected from all clinicians as necessary before employment start dateBuild partnerships and maintain regular communication with clinicians, Legal, Compliance, and Insurance Credentialing Teams to ensure open communication and cooperationBe aware of regulatory developments and quickly adapt documentation requirements, as neededMaintain accountability for the process of clinician documentation and information collection prior to the employment start dateSecurely store provider information in a document libraryTrack expiring documents and collect updates from the provider before expiration date is finalCompetently utilize Excel and Credentialing software to upload clinician information and documents, as well as track expirablesConduct video calls through Teams with new clinicians to walk them through the document collection process as neededEscalate any issues with non-compliant providers or missing documentation to the Compliance Team (failing to comply with documentation and information requests will likely delay the provider's start date)Maintain relationship with Recruiting, Operations, and Locum and Temp agencies and ensure that any clinician hired, even on a temporary basis, has the documentation required to work at one of Elite Dental Partners' locations before start date of employment OTHER JOB RESPONSIBILITIESIdentify and evaluate alternate methods for the document collection and verification process and improvements to the documentation collection and credentialing processAccept other responsibilities as assigned by General Counsel or Vice President of Payor Contracting EDUCATION AND EXPERIENCE 5+ years in dentistry preferredHealthcare/dental safety and compliance experience Regulatory knowledge preferred Excellent communication skills Proficiency with Excel The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements. Additional duties can be assigned as determined.Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce. PI208459783

Keywords: ELITE DENTAL PARTNERS L, Chicago , Clinical Documentation & Credentialing Spc., Healthcare , Chicago, Illinois

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