Credentialing Specialist - Med Staff Admin

Summary:

The Credentialing Specialist works at the direction of the Director of Medical Staff Services. This position performs credentialing and recredentialing for the purpose of Medical and Advance Practice Clinician membership and privileging in accordance with the Medical Staff Bylaws, Rules & Regulations, Policy and Procedure, and in alignment with appropriate regulatory agencies (e.g. DNV, The Joint Commission, NCQA, CMS, etc.)

The Medical Staff Credentialing Specialist manages practitioner files, working cooperatively with practitioners, internal departments, and contract groups ensuring the seamless and timely flow of credentials information in order to meet credentialing deadlines.

Responsibilities:

• Coordinates Medical/APC Staff credentialing (initial, reappointment applications, temporary privileges and requests for additional privileges) from receipt to approval
• Collects and analyzes documents, data and verifications and prepares reports by monitoring data published by regulatory agencies and boards, OIG, NPDB and other applicable sources, screening for any adverse actions
• Collaborates with practitioners and/or contract and practice group contacts regarding status of applications, credentialing issues, pending expirations or expirations of required licensure and certifications, or questions related to credentialing and to ensure timely credentialing
• Coordinate with healthcare providers, insurance companies, and regulatory agencies to resolve discrepancies
• Maintains and updates provider databases and files with current documentation
• Prepare reports and assist in audits to support organizational compliance.
• Ensure compliance with state, federal, and accrediting body regulations - DNV, NCQA, Joint Commission, CMS CoPs, NM state statutes
• Assists with special projects as assigned

Requirements:

Education:

• High School diploma or equivalent required. Two or more years of college in business courses preferred.

Experience:

• Two or more years' experience in health care environment working directly with physicians, advanced practice professionals, and office staff demonstrating the ability to complete assigned tasks independently or with minimum supervision.
• Credentialing or Medical Staff experience desired.
• Above average verbal and written communication skills to promote excellent customer relations, with ability to transmit and receive information accurately
• Strong reading and writing skills in English
• Strong organizational and analytical skills
• Strong understanding of technology with ability to learn new software programs including database and cloud-based services
• Ability to work in stressful situations and perform multiple tasks simultaneously
• Ability to work collaboratively
• Must have critical thinking skills to execute the detailed job functions

Certifications, Registrations, or Licenses:

• Current Certified Provider Credentialing Specialist (CPCS) through the National Association Medical Staff Services (NAMSS) or must become certified within twenty-four (24) months after date of hire.

Work Schedule:

MULTIPLE SHIFTS AVAILABLE

Work Type:

Full Time