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.
• 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.
• High School diploma required.
• Associate degree preferred.
• Entry Level.
• Two (2) years of relevant credentialing experience preferred.
• 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.
• Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.
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