Credentialing Specialist

Per Diem Credentialing Specialist

Reports to the Director of Medical Affairs

POSITION SUMMARY:

 Assist with credentialing , privileging, licensing and provider enrollment applications . Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director, Medical Affairs.

POSITION REQUIRMENTS: 

1. Superb organizational skills and a detail orientation with ability to multitask and handle a number of files at one time.
2. Excellent follow up skills, documenting in credentialing database status of applications to report to management and providers on status of application(s)
3. Ability to work efficiently and independently
4. Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
5. Database management skills including querying, reporting, and document generation.
6. At least 2 years credentialing experience
7. Ability to communicate effectively, both orally and in writing with professionals of different levels-providers, clients, managers, state boards etc
8. Must be proficient in MS Outlook, Word and Excel
9. Must be able to prioritize work with administrative deadlines.

PERFORMANCE EXPECTATIONS: 

1. Analysis practitioner applications and accompanying documents, ensuring applicant eligibility.
2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
4. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on credentialing and privileging issues as they arise.
5. Utilizes credentialing database, optimizing efficiency,  document generation, tracking application status and reporting.
6. Prepares and submits Hospital and Provider Enrollment initial and re-credentialing application and State Licensing Applications  for provider  ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
7. Responsible for tracking status of provider applications
8. Responds to requests from customers and providers regarding credentialing Faxes, scans, copies and files credentialing documentation;
9. Assists Medical Affairs Department with special projects;
10. Other duties as assigned.

KNOWDLEDGE, SKILLS and ABILITIES

1. Ability to communicate effectively, both orally and in writing.
2. Program planning and implementation skills.
3. Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
4. Working knowledge of clinical and/or hospital operations and procedures. (preferred)
5. Informational research skills.
6. Ability to manage and impart confidential information.
7. Database management skills including querying, reporting, and document generation.

PHYSICAL DEMANDS:  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

EOE M/V/F/D