Credentialing Specialist I - Medical Staff Services

JOB SUMMARY :

Responsible for all aspects of the credentialing, re-credentialing, and privileging processes for all medical staff members who provide patient care, treatment, and service at UTMB Hospitals and Clinics.

ESSENTIAL JOB FUNCTIONS :

• Facilitates maintaining a comprehensive credentialing program to ensure compliance with the Medical Staff Bylaws, Rules and Regulations and other accrediting and regulatory agencies such as the Joint Commission, NCQA and URAC.
• Participates and coordinates in the credentialing process for the medical staff, allied health professionals and temporary privileges by presenting and reviewing the files with the appropriate medical staff leadership.
• Enters accurate and up to date data of new providers into the credentialing database to include, but not limited to, demographic and personal information, education / training, licensure, DEA, liability information, board certification status, NPI numbers, ECFMG certifications.
• Conducts thorough background investigation, research, and primary source verification of all components of the credentialing application prior to view of the Department Chair.
• Ensures that all expired credentials are reviewed, obtained, and managed on a timely basis according to the credentialing policy and procedures.
• Ensures a timely and accurate preparation of the FPPE evaluation for providers that requested new and additional privileges.
• Partner with Faculty Relations and Provider Enrollment on issues related to recruitment and Enrollment.
• Provides and engages in excellent customer service with members of the Medical Staff, Hospital Administration and other entities related to organization / department.
• Maintains confidentiality of all business / work and medical staff information
• Works under the supervision of the Medical Staff Services Director or Manager.

MARGINAL OR PERIODIC JOB FUNCTIONS :

REQUIRED EDUCATION / EXPERIENCE :