Credentialing Specialist

Role Description

Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing. Facilitates all aspects of Rural Physicians Group credentialing, including:

• Initial appointment
• Reappointment
• Expirables process
• Clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the contracted hospital client’s Medical Staff Bylaws, policies, or related contracts

Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Credentialing.

Qualifications

• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year-for-year basis.
• High school diploma or GED; at least 4 years of experience with 2 years directly related to hospital medical staff or physician credentialing.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred.

Requirements

• Leads, coordinates, drafts and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Responsible for tracking and ensuring timely completion of all reappointments for each physician at each facility.
• Scrutinizes provider applications and CVs for completion, consistency, and accuracy.
• Conducts thorough background investigation, research, and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
• Prepares applications for hospital privileges and medical malpractice insurance for completion.
• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day credentialing and privileging issues.
• Assists with managed care delegated credentialing audits; conducts internal file audits.
• Utilizes the MDStaff credentialing database, optimizing efficiency, and performs query, report, and document generation.
• Conducts compliance and sanctions monitoring, notifying the Director of Credentialing of negative findings immediately.
• Monitors the initial, reappointment, and expirables process for all medical staff, ensuring compliance with regulatory bodies.
• Monitors and reports on the credentialing progress of each physician.
• Responds timely to all requests from Physicians, Clients, or their Medical Staff Services departments.
• Performs miscellaneous job-related duties as assigned.

Benefits

• Competitive salary
• Incentivized bonus plan
• Ability to work remotely from home
• Three weeks of paid time off, accrual starting first day
• Comprehensive medical, dental, and vision insurance plans
• 401(k) with company match
• Health Savings Account
• Basic Life Insurance coverage
• Cell Phone Allowance