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 credentials files. Responsible for timely and accurate completion of routine and assigned credentialing tasks (see major activities listed)

Specific Activities Include

• Process pre-applications
• Prepare application packets and send to provider for completion
• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy and compliance with organization guidelines, regulations, policies and standards
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitioners
• Discovers and conveys 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, 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
• Sets up and maintains provider information in online credentialing databases and system
• Maintains 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
• Maintains confidentiality of provider information
• Performs miscellaneous job-related duties as assigned

Qualifications Education High School diploma required; Associate degree preferred; Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.

Minimum Work Experience Entry Level; two (2) years of relevant credentialing experience preferred.

Required Skills, Knowledge, And 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