Credentialing Specialist

About This Role

The Credentialing Specialist is responsible for managing the credentialing, re-credentialing, and privileging processes within the organization. This role involves maintaining accurate files and ensuring compliance with guidelines, reporting directly to the System Director of Medical Affairs and Provider Enrollment.

Responsibilities

• Process and maintain credentials files
• Complete timely and accurate routine and assigned credentialing tasks
• Process pre-applications
• Prepare application packets and send to provider for completion
• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with organization guidelines, regulations, policies, and standards
• Identify, analyze, and resolve extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential practitioners
• Discover and convey problems to Medical Affairs for sound decision-making in accordance with Medical Staff Bylaws and credentialing policies and procedures
• Participate in the development and implementation of process improvements for the system-wide credentialing process
• Communicate clearly with providers, their liaisons, Medical Affairs, Medical Staff leadership, and administration as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise
• Set up and maintain provider information in online credentialing databases and system
• Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry
• Perform primary source verification for all required elements of the credentialing file
• Coordinate with the Medical Staff Office to submit completed files for recommendation/approval through the Medical Staff process
• Maintain confidentiality of provider information
• Perform miscellaneous job-related duties as assigned

Requirements

• High School diploma required
• Knowledge and understanding of the credentialing process
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills including letters, memos, and emails
• Excellent attention to detail
• Ability to research and analyze data
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
• Proficient use of Microsoft Office applications (Word, Excel) and internet resources

Nice to have:

• Associate degree
• Certification as a Certified Provider Credentialing Specialist (CPCS)
• Two (2) years of relevant credentialing experience