Credentialing Specialist

Overview

The Credentialing Specialist is accountable for performing the credentialing, re-credentialing and privileging process for the organization.  The Credentialing Specialist reports directly to the System Director of Medical Affairs and Provider Enrollment.

Responsibilities

• Responsible for processing and maintaining credentialing files.

• Responsible for the timely and accurate completion of routine and assigned credentialing tasks.

• Processes pre-applications.

• Prepares application packets and sends them to providers for completion.

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with organizational guidelines, regulations, policies, and standards.

• Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps, and other issues that could adversely impact the ability to credential practitioners.

• Discovers and communicates problems to Medical Affairs for sound decision-making in accordance with Medical Staff Bylaws and credentialing policies and procedures.

• Participates in the development and implementation of process improvements for the system-wide credentialing process.

• Communicates clearly with providers, provider liaisons, Medical Affairs, Medical Staff leadership, and administration to provide timely responses regarding credentialing and privileging issues.

• Sets up and maintains provider information in online credentialing databases and systems.

• Maintains professional growth and development through seminars, workshops, and professional affiliations to stay current with regulations, legislation, and industry best practices.

• Performs primary source verification for all required elements of the credentialing file.

• Coordinates with the Medical Staff Office to submit completed files for recommendation and approval through the Medical Staff process.

• Maintains confidentiality of provider information.

• Performs miscellaneous job-related duties as assigned.

Qualifications

Education

• High School diploma required.

• Associate degree preferred.

Experience

• Entry Level.

• Two (2) years of relevant credentialing experience preferred.

Required Skills, Knowledge & Abilities

• 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.

Licenses & Certifications

• Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.