Credentialing Specialist

Credentialing SpecialistThe 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.ResponsibilitiesResponsible 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-applicationsPrepare application packets and send to provider for completionReviews and screens initial and reappointment credentialing applications for completeness, accuracy and compliance with organization guidelines, regulations, policies and standardsIdentifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitionersDiscovers and conveys problems to Medical Affairs for sound decision making in accordance with Medical Staff Bylaws and credentialing policies and proceduresParticipates in the development and implementation of process improvements for the system-wide credentialing processCommunicates 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 ariseSets up and maintains provider information in online credentialing databases and systemMaintains 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 industryPerform primary source verification for all required elements of the credentialing fileCoordinate with the Medical Staff Office to submit completed files for recommendation/approval through the Medical Staff processMaintains confidentiality of provider informationPerforms miscellaneous job-related duties as assignedQualificationsEducation: 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 processAbility to organize and prioritize work and manage multiple prioritiesExcellent verbal and written communication skills including letters, memos and emailsExcellent attention to detailAbility to research and analyze dataAbility to work independently with minimal supervisionAbility to establish and maintain effective working relationships with providers, management, staff and contacts outside the organizationProficient use of Microsoft Office applications (Word, Excel) and internet resources