What are the responsibilities and job description for the Medical Staff Credentialing Specialist position at Inova Health System?
The Centralized Credentialing Specialist processes practitioner applications for initial appointments and / or reappointments by following The Joint Commission (TJC), National Committee for Quality Assurance (NCQA) and other State Regulatory requirements. Thoroughly reviews and evaluates applications. Identifies extraordinary information, discrepancies, time gap and obtains additional explanation and information as required. Plays a proactive role in process improvement.
Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.
Featured Benefits :
Committed to Team Member Health : offering medical, dental and vision coverage, and a robust team member wellness program.
Retirement : Inova matches the first 5% of eligible contributions - starting on your first day.
Tuition and Student Loan Assistance : offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
Mental Health Support : offering all Inova team members, their spouses / partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
Work / Life Balance : offering paid time off, paid parental leave, and flexible work schedules
Processes practitioner applications for initial appointment and / or reappointments.
Manages, supports and maintains credentials files on all medical staff members and advanced practice providers. Consults and works with other hospital departments to coordinate process.
Assures compliance with regulatory requirements and accrediting body standards, Bylaws and policies. Consistently reviews regulatory requirements, accrediting body standard, Bylaws and policies to maintain current knowledge.
Initiates and processes application with thorough review and evaluation.
Plays a proactive role in improving processes within the department for maximum efficiency by participating / leading process improvement activities.
Communicates status of application to practitioners and all interested parties.
Appropriately identifies and escalates extraordinary information, time gaps and potential discrepancies and adverse information, and independently investigates and validates information on applications, primary source verifications or other sources.
Conducts follow-up and research regarding additional required information. Documents appropriately.
Manages, supports and maintains the Network Insurance Credentialing process for appropriate employed practitioners.
Completes audit updates on Network Insurance files
Experience in credentialing, preferably in a centralized credentialing environment or within a healthcare facility such as a hospital or medical group.
Knowledge of medical terminology and healthcare operations.
Proficient in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) with strong data entry and reporting skills.
Excellent verbal and written communication skills, with the ability to interact professionally with providers, leadership, and external organizations.
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