Provider Credentialing Specialist

Job Summary

The Provider Credentialing Specialist ensures that all new and practicing providers within the organization meet regulatory, accreditation, and organizational standards. This position will collect, verify, and evaluate provider credentials including education, training, licensure, certifications and work history. This position will oversee the processing of medical staff applications and re-applications of current providers as well as preparing verification letters and reviewing applications for accuracy and completeness. The Credentialing Specialist will perform all duties in compliance with the Medical Staff bylaws, accrediting and regulatory agencies and will prepare all completed packets for review at Credentials Committee. This position accurately maintains all medical staff healthcare providers' data in the MSO database and ensures all mandatory expirables are audited, reviewed, obtained from the providers and entered in the system in a timely manner and alerting leadership when expirable items affect the practitioners' ability to maintain credentialing requirements. The Specialist may provide assistance with provider support responsibilities, Family Residency Program, Medical Staff Office assignments, payor credentialing and other administrative tasks as assigned. The Provider Credentialing Specialist must maintain the confidentiality of all business/work and medical staff information.


Minimum Job Requirements

• Associate's degree in Business Administration, Billing/Coding, Healthcare Administration, or a related field with one (1) year of relevant experience; or
• High school diploma with three (3) years of relevant experience.

Preferred Job Requirements

• Provider credentialing experience.
• Medical Staff Office experience

Skills / Knowledge / Abilities

• Excellent communication skills to effectively and tactfully communicate with patients and their families and guests, co-workers, managers, providers and other hospital personnel on a one-to-one basis using appropriate grammar, vocabulary and word usage.
• Interpersonal skills necessary in order to carry out duties in a professional manner, as well as the ability to work well under stress.
• Excellent time management, and organizational skills.
• Ability to problem solve, multi-task in a fast-paced setting and work well in a team environment.
• Developed computer skills to include proficiency with Microsoft Office, telephone system and the ability to learn and proficiently perform computer applications related to department operations and job function.
• Excellent customer service skills.
• High degree of accuracy with concentration and close attention to detail.
• Ability to be discreet and protect the integrity of any confidential matter or information encountered during the performance of job duties.

Working Conditions

• Typical office environment with prolonged sitting.
• Work subject to interruption and occasional high stress levels.
• Ability to work occasional extended hours, evenings and/or weekends based on the needs of the department.
• Works with protected health information.

Physical and Mental Activities, Tools and Equipment

• Use of personal computer and other standard office equipment including but not limited to: telephone, fax, copier, calculator, and scanners.
• Lifting, pushing, pulling, walking sitting, reaching, bending, kneeling or stooping to perform duties in a safe manner.
• Repetitive wrist, finger and hand movement.
• Occasional manipulation of large volumes of books, charts, reports or files.
• Lift supplies or equipment.

Equal Opportunity Employer
Marion Health is a smoke-free environment.