Credentialing Specialist, Sr.

Position Summary

Status: Full Time

Location: Downtown Orlando


Schedule: Monday- Friday, hybrid after training period

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida's east to west coasts and beyond.

ORLANDO HEALTH - BENEFITS & PERKS:

Forbes Recognizes Orlando Health as a Best-In-State Employer

• Forbes has named Orlando Health as one of America's Best-In-State Employers for 2024. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued.

Employee-centric

• Orlando Health has been selected as one of the "Best Places to Work in Healthcare" by Modern Healthcare

Position Summary

• The Credentialing Senior Specialist provides support and acts as liaison to physicians and other medical staff department members
  ensuring all medical staff credentialing is acted upon in a consistent and timely manner. May oversee other Credentialing
  Specialists.

Responsibilities

Essential Functions
• The Credentialing Specialist Sr. is responsible for completion of initial and reappointment applications for physicians, assuring
compliance with regulatory and accreditation standards, as well as the Orlando Health Bylaws, Policies and Procedures, Rules &
Regulations.
• Coordinates the timely processing of all activities of initial and reappointment applications for completeness and in accordance
with appropriate standards relative to the organizations Credentialing Manual. Provides credentialing support to the
credentialing manager and supervisor. Maintains a sound working knowledge of credentialing and provides consultation to the
Network regarding credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies as
demonstrated by observation.
o Communicates with Medical Staff Liaisons during the credentialing process..
o Preparation and accuracy of credentialing reports at least one week prior to dues date for submission to
Management.
o Researches incidents, submission of applications for timely processing, and request appropriate follow-up information
as needed.
o May be responsible to gather information and perform research in credentialing disputes under the direction of the
Management.
o Protects confidential information for peer review by the authorized personnel.
• Secures appropriate peer competency references and prepares credentials files. Obtains primary source and other verifications
in accordance with established guidelines. Communicates with applicants during credentialing process to ensure timely and
expeditious completion of process. Researches incidents, malpractice claims, advisory letters/letters of concern etc and request
appropriate follow-up information from practitioner or other sources as indicated.
• Initiates and participates in cross-training and cross-coverage of credentialing departmental functions. Serves as departmental
resource to employees. Mentors and assists other Credentialing Specialists in all aspects of credentialing functions and training.
• Maintains the credentialing database. Ensures data is accurately entered as evidenced by audit. Prepares reports in compliance
with requests for information as demonstrated by documentation.
• Participates in departmental PI initiatives, including regulatory preparedness.
• Coordinates and completes special projects in a timely manner. Appropriately prioritizes all tasks so that deadlines are met with
continued focus on quality. Keeps staff apprised of any critical or major situations.
• Drafts and assists in writing and reviewing policies and procedures and department rules and regulations. Ensures these do not
conflict with medical staff by-laws and hospital policies and procedures/protocols.
• Interacts on a daily basis with medical staff leadership, department chairs, administration medical staff services team and
executive staff.
• Provides exceptional customer service to all internal and external customers, including physicians, advanced practice
professionals their office staff, other departments, and within the Medical Staff Services team.
• Assists Medical Staff Supervisor with preparation for Credentials Committee and credentialing report to Medical Executive
Committee and Board of Directors. Interacts with and provides support to department chairmen and leadership chairmen in
the preparation of credentials files and
• Clinical Privilege Descriptions.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state
and local standards.
• Maintains compliance with all Orlando Health policies and procedures.


Other Related Functions

• Assists physicians and others with all matters relative to Medical Staff membership and clinical privileges. Develops and
  maintains a working knowledge of statutes and laws as relates to credentialing/privileging.
• Maintains confidentiality.
• Assumes responsibility for professional growth and development.

Qualifications

Education/Training

• High school graduate or equivalent. Knowledge of medical terminology. Associate degree in business, health care, accounting
  or related field may be substituted for two years of experience.

Licensure/Certification
None

Experience

• Four (4) years of experience credentialing/privileging.
• Experience with credentialing/privileging and working with Joint Commission and/or NCQA standards.
• Experience in completion of meeting minutes.
• Proficiency in Microsoft Word, Excel, Internet and significant proficiency in credentialing data system skills necessary to
  maintain credentialing, meeting support activities, and reporting abilities relative to physician and advanced practice
  professional activity and statistics.