Credentialing Analyst III

Credentialing Analyst III- Medical Staff Office

Verifies the identity and qualifications of Medical Staff and Allied Health Professionals to ensure each practitioner meets the requirements of the credentialing process and policies of the NewYork-Presbyterian. Analyzes and

evaluates the business needs and serves as the liaison between the provider, business/department, quality, Human Resources, Risk Management, and operation teams. Collaborates with departmental leadership, the Chief Medical Officer, Risk Management and Credentials Committee membership to assist and facilitate review and evaluation of potential issues determined through the credentialing process. Acts as the internal expert of NewYork-Presbyterian credentialing policies and procedures and is responsible for knowing what changes have been made to the process. Participates in quality review of coordinator files, coordination and organization of

regulatory audits (e.g., TJC, CMS, DOH); assists with defining measurable and actionable metrics; administration of objectives within the credentialing platform, development of relationships including interactions with

departments, administration, clinical leadership, and physicians.

Essential Job Duties

• Reviews quality of credentialing performed by coordinators. Ensures quality of credentialing activities, accuracy and organization of files, and accuracy of data in the credentialing database.
• Performs pre-audit of files being submitted to committee, file reviews for surveys/audits; ensures files meet hospital and regulatory standards.
• Participates in all aspects of the credentialing and/or re-credentialing process for the Medical Staff and Allied Health Professionals, including:
• Organizes and reviews applications for completeness and accuracy. Performs verifications of education, training, experience, certifications, and boards. Ensures that requests for privileges follows criteria outlined in the department’s delineation of privileges. Identifies and escalates red-flag issues. Organizes documentation for departmental and committee review and approval. Records and maintains practitioner information in electronic and hard copy filing systems ; including, but not limited to, data entry, accurate maintenance of the credentialing database, and safeguarding private/confidential information.
• Monitors industry trends and provides information and guidance regarding changes/updates to medical staff bylaws, medical staff rules and regulations, and regulatory standards (e.g., Joint Commission, Center for Medicare and Medicaid Services, board agencies).
• Participates in the timely preparation and delivery of agenda and documentation to committee meetings.
• Acts as a customer service liaison and organizes the credentialing process with medical staff personnel, department representatives, licensing agencies, and insurance carriers.
• Assesses and re-prioritizes work in accordance with shifting priorities and backlog.
• Operational Performance:
• Assists in the coordination of credentialing activities that optimize best practices for physician and department satisfaction. Ensures active communication with all external and internal constituents to establish strong relationships that are complimentary and consistent with organizational goals and strategic needs. Ensures that time is properly allocated to achieve credentialing deliverables and expectations of clients/physicians/providers while adhering to credentialing standards.
• Establishes and maintains working relationships with the organization to obtain information and content from providers for health system selections.
• Serves as an operational resource for internal team members regarding expedited problem identification and resolution, provision of credentialing-specific updates, and team interactions and deadlines .
• Provides clear and timely written/verbal status updates to applicants and departmental administrators.
• Provides feedback to leadership regarding coordinators during annual performance evaluations.
• Performs other special projects and duties as assigned.

Required Criteria

• Bachelor’s degree or equivalent experience
• 3 years credentialing experience (hospital, medical affairs or equivalent a plus.)
• Knowledge of commonly used concepts, practices, and procedures used in health care and physician credentialing.
• Advanced Microsoft Office skills (MS Word, Excel, Power Point)
• Experience with Cactus or Morrisey Software systems, or similar credentialing system.
• Highly motivated and meticulous with excellent problem-solving and communication skills to join a fast-paced, growth-oriented work environment in a cutting-edge field of clinical operations
• Knowledge of related Joint Commission, NCQA, and CMS standards
• Knowledge of medical credentialing and privileging procedures and standards
• Ability to analyze, interpret and draw inferences from research
• Proficiency in using independent judgment to manage and maintain confidentiality of information
• Informational research skills
• Database management skills including querying, reporting, and document generation
• Skilled aptness to make administrative/procedural decisions and judgments
• Ability to plan and organize work
• Propensity to communicate clearly and effectively, both verbally and in writing with all levels of the organization

“Requires on-site presence 1 day a week; therefore, should live within a commutable distance. No relocation assistance available.”

Preferred criteria

• NAMSS Certified Provider Credentialing Specialist (CPCS)

Join a healthcare system where employee engagement is at an all-time high. Here we foster a culture of respect, diversity, and inclusion. Enjoy comprehensive and competitive benefits that support you and your family in every aspect of life. Start your life-changing journey today.

Please note that all roles require on-site presence (variable by role). Therefore, all employees should live within a commutable distance to NYP.

NYP will not reimburse for travel expenses.

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• 2024 “America’s Best Large Employers” – Forbes
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• 2023 “Workplace Well-being Platinum Winner” – Aetna
• 2023 “America’s Best-In-State Employers” – Forbes
• “Silver HCM Excellence Award for Learning & Development” – Brandon Hall Group

NewYork-Presbyterian Hospital is an equal opportunity employer.

Salary Range:

It all begins with you. Our amazing compensation packages start with competitive base pay and include recognition for your experience, education, and licensure. Then we add our amazing benefits, countless opportunities for personal and professional growth and a dynamic environment that embraces every person. Join our team and discover where amazing works.