Corporate Credentialing Specialist

Credentialing Specialist

The Credentialing Specialist coordinates and organizes ongoing credentialing and privileging of physicians and advanced practice professionals. Responsible for reviewing, analyzing, and follow-up of credentialing and privileging applications, maintaining strict confidentiality. Ensures compliance with federal and state agencies, organizational policies, and accrediting and regulatory agencies.

Key Responsibilities:

• Coordinates and organizes credentialing/privileging requests/modifications for an SHC facility and supports providers requesting privileges at affiliate locations. Ensures evidence of education, training, and experience to determine eligibility for requested privileges and membership.
• Verifies and documents credentials and expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards, as well as manages and documents all communication with providers and primary facilities to ensure notification of upcoming expirables. Keeps a record of all credentialing activities in the credentialing database to ensure files reflect current status.
• Recognizes, investigates, and validates discrepancies and adverse information obtained; obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance.
• Responsible for confidentiality and data entry, maintenance, and analysis of clinical provider information within database per established guidelines to ensure complete electronic credential file to support provider enrollment and delegation requirements.
• Collaborates credentialing, OPPE, FPPE, and privileging activities with SHC Medical Staff Offices to ensure timely approval process of governing bodies, participation in accreditation surveys and audits, to include verification of appropriate drug and criminal background screenings. Prioritizes workload to meet deadlines.
• Maintains current knowledge of accreditation standards (TJC, NCQA), state and federal regulations, as well as SHC medical staff bylaws, regulations, and procedural rules.

Required Qualifications:

• Experience in a healthcare setting performing regulatory credentialing
• Experience with MD Staff or relevant credentialing database
• Data entry skills. Including the ability to navigate a translational database to enter and retrieve information.
• Competency in Microsoft Office applications
• Certified Provider Credentialing Specialist (CPCS), Certified Professional in Medical Services Management (CPMSM) or equivalent certification. If candidate is not currently certified, CPCS will be required within 24 months of hire, or upon eligibility

Preferred Qualifications:

• Associates Degree (A.A.) in relevant healthcare field
• Bachelor's Degree (B.S., B.A., etc.) in relevant healthcare field

The pay range for this position is $24.16 - $36.24. Compensation is determined based on years of relevant experience and departmental equity.