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). 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 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 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 #J-18808-Ljbffr