This class is responsible for the maintenance of the credentialing and re-credentialing applications for various CSB providers. Ensures applications are complete, timely, and accurate. This position will also assist the Credentialing Coordinator with various workers’ compensation and procurement administrative duties.
DISTINGUISHING ELEMENTS OF THE CLASS:
I. IMPACT: The public image of the agency and division are affected by the manner in which the incumbent of this class handles the credentialing and re-credentialing activities. Appropriate processing of the credentialing applications and recertification to ensure quality services and proper reimbursements for services are received. The general productivity, quality, and timeliness of the office work are affected directly by the work of the incumbent. This position will also be responsible for assisting staff with general workers’ compensation questions and inquiries. Additionally, this position will assist with procurement and product order activities.
II. LATITUDE: Work is performed independently. The Supervisor will occasionally review completed work. Frequent independent judgment and discretion is required due to the varied and often complex nature of transactions occurring in the agency.
III. RESPONSIBILITY FOR THE WORK OF OTHERS: None.
IV. INTERPERSONAL CONTACTS: Daily contacts with all levels of agency staff, managed care insurance companies, workers’ compensation representatives, and various product or service vendors. Incumbent has regular interactions with managed care provider service representatives, regulatory agency personnel and local public sector agency personnel. In discussions with personnel outside the agency, the incumbent will be speaking as a representative of the agency with decision making authority in some instances.
V. DIFFICULTY: This class will be responsible for the processing of maintaining the credentialing database and cross referencing such to the provider information and all applicable event rules and regulations. Accuracy and attention to detail are required in the preparation and maintenance of all credentialing and re-credentialing applications. Work is rarely performed in a scheduled manner and is usually constrained by limited time frames and rigid deadlines. This position will need to be responsive to employee concerns regarding workers’ compensation inquiries.
VI. COMMUNICATIONS: Work requires original drafting of correspondence. Frequent face-to-face, telephone and e-mail communication with agency staff is required and other personnel outside the agency.
VII. EQUIPMENT/FACILITIES RESPONSIBILITY: Daily, sometimes prolonged use of a computer and telephone is required. Incumbent also uses a fax, scanner and other common office and computer related equipment.
VIII. WORKING CONDITIONS: Work is performed in a typical office environment. Due to the extensive use of a computer, physical fatigue from repetitive data entry is common.
IX. KNOWLEDGE, SKILLS, AND ABILITIES (KSA’S):
Comprehensive knowledge of agency credentialing, and administrative policies and procedures.
Knowledge of Virginia Workers’ Compensation laws and regulations.
Outstanding knowledge of agency services and the procedures and treatments involved.
Familiar with managed care organizations credential and re-credentialing process and procedures.
Familiar with procurement policies and procedures.
Good knowledge of the behaviors related to the various disabilities of the clients served by the agency.
Outstanding knowledge of credentialing and provider applicable databases involved in the work.
Comprehensive knowledge of the operations of computer assisted clinical database systems.
Comprehensive knowledge of agency functions and organization.
Comprehensive skills in maintaining clinicians credentialing profile and records.
Outstanding ability to work effectively with agency employees and personnel outside of the agency.
X. LICENSURE: None.
XI. PRINCIPAL DUTIES AND RESPONSIBILITIES OF CLASS (ILLUSTRATIVE ONLY):
Manages the credentialing and re-credentialing application for the CSB providers with various insurance agencies. Ensures applications are complete, timely, and accurate.
Ensure all CSB providers maintain current licenses, DEA, and CEUs.
Prepares credentialing applications, including gathering of applicable material.
Works with key department staff regarding the processing of workers’ compensation process.
Resolves computer related problems with IT department and/or outside software consultants.
Maintains related manual and electronic records and files.
Assist with maintaining the agency’s workers’ compensation claims process and administration in coordination with our third party vendor.
Assist with various procurement functions and activities as requested.
Does related work as required.
XII. PHYSICAL REQUIREMENTS: Must have the use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone and personal contact as normally defined by the ability to see, read, talk, hear, handle or feel objects and controls. Physical capability to effectively use and operate various items of office related equipment, such as, but not limited to a, personal computer, calculator, copier, and fax machine. No significant walking, moving, carrying, climbing, bending, kneeling, crawling, reaching, and handling, sitting, standing, pushing, and pulling.
High School Diploma or equivalent and one (1) year provider credentialing experience.
College Transcripts Not required.
Department of Motor Vehicle Driving Record Not required.
Annual Salary $26,171.39
Shift -not applicable-
Number of Openings 1
Open Date 9/1/2017
Professional Licenses and/or Certifications