Credentialing Specialist - Full time - Detroit

Credentialing Specialist

Under general supervision, responsible for all functions relating to the credentialing and recredentialing of practitioner applicants. Responsibilities include data entry, data collection, and verification of credentials from primary source and analyzes information collected for presentation to medical staff leadership.

Principal duties and responsibilities:

• Responsible for verifications for medical staff and allied health professionals initial appointments, provisional reviews, reappointments and privilege delineation; a. Coordinates the processing of applications. Assure all applications are processed completely and in a timely manner;
  • Verifies required primary source credentialing documentation to ensure medical staff and allied health professional files are current and policies and procedures have been followed to obtain required documentation and verification;
  • Coordinates activities and explains procedure to facilitate the reappointment process;
  • Request confidential information such as case logs, procedures and other sensitive matters;
  • Tracks responses and follows-up on items not received within established time frames;
• Maintains credentialing software database by ensuring that data entered is complete and accurate;
• Submit completed files to MSO offices and delegated entities;
• Acts as a liaison between Henry Ford Health System facilities and the CCS.
• Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information;
• Assist in compliance with the accrediting and regulatory agencies (i.e. The Joint Commission, NCQA, URAC, HFAP) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws;
• Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the CCS by participating in professional organizations, attending seminars and reading journals and publications addressing medical staff services activities and trends;
• Participates in system integration and continuing quality improvement efforts;
• Receives, evaluates and answers customer inquiries and provides customer support in accordance with corporate standards of excellence;
• Performs other duties as required which are subject to change at the discretion of management.

Education/Experience Required:

• High School Diploma required. Associate's Degree, preferred.
• 1 year of credentialing, provider enrollment, or background/verification specialist experience required.
• High level of energy to work in a fast paced environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking.
• Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act if 1996 and all applicable standards.

Physical Demands/Working Conditions:

• Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
• Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS' Customer Service Policy
• Must practice the customer skills as provided through on-going training and in-services.