AdventHealth Corporate

All the benefits and perks you need for you and your family:

·    Benefits from Day One

·    Career Development

·    Whole Person Wellbeing Resources

·    Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift: Monday-Friday

Job Location: Remote

The role you’ll contribute: 

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Adventist Health Systems (AHS) credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Centralized Verification Office (CVO) Manager.

 The value you’ll bring to the team:

·       Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

·       Conducts thorough background investigation, research, and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.

·       Achieves productivity standards as determined by management.

·       Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up.

·       Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.

·       Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.

·       Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.

·       Assists with managed care delegated credentialing audits; conducts internal file audits.

·       Utilizes the MSOW/Apogee credentialing database, optimizing efficiency, and performs query, report, and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.

·       Monitors the initial, reappointment and expirable process for all AHS employed physicians, allied health professional staff, other health professional staff, delegated and community CIN providers affiliated with AHS. Responsible for ensuring compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.

·       Performs miscellaneous job-related duties as assigned.