CREDENTIALING SPECIALIST

Job Title

Credentialing Specialist

Job Description

Assist with credentialing and maintenance of medical staff credentials files to ensure compliance with state, federal and accrediting agency regulations.

Essential Job Functions

• Insure the proper deployment of the credentialing and privileging process for new applicants and reappointments.
• Conduct primary source verifications.
• Obtain peer references, peer review documentation and current clinical competence evidence.
• Maintain compliance with state and federal accreditation standards and regulatory requirements.
• Perform detailed and thorough review of applications, primary source verifications and other information to present to manager.
• Recognize potential discrepancies and adverse information, investigate, and escalate to leadership as indicated.
• Analyze and maintain data.
• Maintain electronic database.
• Verify and document expirable documents using acceptable verification sources to comply with accreditation and regulatory standards.
• Serve as a main point of contact for applicants.
• Serve as a contact for external queries.
• Insure timely completion of application process in accordance with medical staff policies and accreditation and regulatory standards.
• Other duties as assigned.

Competency and Experience [Knowledge, Skills and Abilities]

Required Qualifications/Experience

• Associate's Degree in business or health related field or more than two (2) years experience working in the Medical Staff Services environment.
• Zero (0) to two (2) years of experience in Medical Staff Services, credentialing, or privileging or proven specific related experience.
• Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
• Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
• Ability to multitask and prioritize assignments.

Preferred Qualifications/Experience

• CPCS (Certified Provider Credentialing Specialist certification or CPMSM (Certified Professional Medical Services Management certification).
• Bachelor's Degree in business or health related field preferred.
• Three (3) to five (5) years' experience in Medical Staff Services, credentialing, or privileging.
• Experience in Healthcare setting.

License, Certification & Clearances

• Act 34-PA Criminal Record Check from the PA State Police system

Position Type/Expected Hours of Work

• Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
• Travel may be expected locally between System locations.

Equal Employment Opportunity

Independence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations.

Disclaimer

This job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Work Environment

Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines