Credentialing Specialist

Responsibilities

• Process pre-applications
• Prepare application packets and send to provider for completion
• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy and compliance with organization guidelines, regulations, policies and standards
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitioners
• Communicates clearly with providers, their liaisons, Medical Affairs, Medical Staff leadership and administration as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise
• Sets up and maintains provider information in online credentialing databases and system
• Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry
• Collaborate with the Medical Staff Office to submit completed files for recommendation/approval through the Medical Staff process
• Performs primary source verification for all required elements of the credentialing file
• Performs miscellaneous job-related duties as assigned

Qualifications

• High School diploma required; Associate degree preferred; Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.
• Minimum Work Experience: Entry Level; two (2) years of relevant credentialing experience preferred.
• Required Skills, Knowledge, And Abilities: Knowledge and understanding of the credentialing process; Excellent verbal and written communication skills including letters, memos and emails; Excellent attention to detail; Ability to research and analyze data; Ability to work independently with minimal supervision; Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization; Proficient use of Microsoft Office applications (Word, Excel) and internet resources.