What are the responsibilities and job description for the Credentialing Specialist position at Sherman MD Providers Inc?
Overview: The Credentialing Specialist will verify the accuracy and validity of healthcare professionals' credentials, licenses, and certifications, ensuring compliance with regulatory and organizational standards. This role is essential to maintaining the integrity of our healthcare team and ensuring that all professionals meet the necessary qualifications to provide safe and effective care.
Job Description: Under the direction of supervisor, the credentialing specialist is responsible for coordinating all aspects of the credentialing and recredentialing process as well as changes in privileges specialty or demographic information for healthcare professionals practicing within the organization. Responsible for monitoring and managing credentials/recredentialing requirements to ensure the collection of all required renewals are on file within their required time frame.
Key Responsibilities:
- Credentialing specialist, meticulously reviews, and verify the educational background, licenses, certifications, and work experience of healthcare providers. Conduct primary source verification, contacting educational institutions, licensing boards, and previous employers to validate information.
- Perform background checks, including criminal record checks to identify potential risk or red flags. Ensure that the healthcare providers meet the necessary qualifications and comply with industry, standards and regulatory requirements. Maintain accurate and up-to-date records for healthcare professionals' credentials. Advise staff members on renewal dates for licenses and credentials to help ensure that they can continue to work legally without lapses.
- Specialists must often maintain large databases containing confidential employee information. Timely entry processing and tracking of credentialing files. Uphold and ensure compliance confidentiality and adhere to all HIPAA guidelines and maintain a strict level of confidentiality for all company policies and procedures, departmental and healthcare provider information as well as the overall mission and values of the organization. Assist with credentialing audits.
- Ensure all tasks duties comply with all regulatory and accreditation standards including, The Joint Commission and the National committee Quality Assurance (NCQA) guidelines.
- Reports any issue in a timely manner to manger, to ensure decision making in accordance with the credentialing and privilege policy and federal state, local and government and health plans standards.
- Communicates clearly with supervisor and with providers, their credentialing representatives and leadership, as needed to provide timely updates and responses on a day-to-day credentialing and privileged issues as they arise.
- Perform other job-related duties as assigned
Qualifications:
- High school Diploma or higher- Required
- Certified Provider credentialing specialist ( CPCS) Required
- 1-3 years of previous employment as a credentialing specialist- Required
- Certified Professional Medical Services Management(CPMSM) - Preferred
- Previous experience creating databases and/or inputting data (data entry)
- Knowledge of federal and state regulatory agencies and accrediting bodies(CMS,TJC,NCQA,etc)
- CPR/BLS -Required
We look forward to reviewing your application and potentially welcoming you to our team at Sherman Medical Group!