Credentialing Manager/Privacy Compliance-301

Credentialing Manager/Privacy Compliance:


This positon is in charge of performing all of the credentialing for
approximately 80 physicians.  It involves completing the initial credentialing
and re-credentialing appliations for various insurance carriers, maintaining
hospital privilege appointments and reappointments.  Credentialing software is
available to streamline the completion of the insurance carrier applications,
however some applications do need to be completed manually.

 

Involves the overseeing of the Compliance and Privacy for the
entire practice. Most Cmpliance and Privacy area, it is necessary to have
knowledge and experience in perfomring regular audits of dictation by the
physicians to ensure that dictation supports the biling.  Also, it is necesssary
to be aware of the legalities of fraud and abuse and to oversee practive
operations to avoid these things from occurring.
 
With regard to Privacy, this involves thorough knowledge of the HIPPA laws set
forth by the Office of Inspector General.  This position must oversee all of the
annual basis for HIPPA training to re-enforce the Privacy laws and have
employees sign confidentiality and compliance acknowledgements.  This position
also reports to the Compliance Committee on any Privacy or Compliance concerns
that occure.