Credentialing Specialist

About the role

The Credentialing Specialist works as a part of the administrative team and is responsible for ensuring that healthcare professionals and the organization are qualified and meet the necessary requirements to provide services to patients. The individual will verify and organize all aspects of the credentialing and privileging processes and maintain current files on providers, pharmacists, technicians, nurses, medical assistants, and other staff as deemed necessary.

Responsibilities

• Maintains compliance with all regulatory and accrediting institutions.
• Responsible for gathering and verifying highly confidential and sensitive healthcare professional credentials consistent with policies, procedures, and accreditation standards.
• Manages staff credentials and licenses and ensures accurate data entry to confirm the integrity of credentialing and privileging information within the recredentialing software.
• Works directly with Johnson Health Center (JHC) staff regarding all credentialing and privileging needs and updates and responds to internal and external inquiries in a timely manner.
• Makes sure expiring licensure, board, and professional certifications, and other expirable documents are within the prescribed timeframe.
• Screens applications and supporting documentation to confirm eligibility and ensure completeness of the application in preparation for the verification process.
• Collaborates with Compliance, HR, Billing, and Central Verification Officer (CVO) to facilitate and ensure smooth hand off during the credentialing process, as well as informing them of credentialing issues.
• Ensures proctoring is completed and signed off on all new providers and other providers as necessary.
• Provides recommendations to the Medical Management Committee on new hire credentialing based on a tiered system to identify any credentialing concerns.
• Monitors credentialing software to ensure each provider has the appropriate and up-to-date privileges.
• Tracks facility licenses within the software, provides advanced reminders to the proper leadership of upcoming renewals, and assists as needed.

Qualifications

• A high school diploma, GED, or suitable equivalent.
• One to two years of credentialing experience with healthcare professionals.
• Knowledge of credentialing and privileging procedures and standards.
• Strong organizational skills.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.

Other Functions

• The staff member will abide by the Code of Conduct as documented in the Corporate Compliance Manual.
• Treats all patients and staff with dignity and respect, mindful of the cultural differences of the diverse population we serve.

JHC Core Values

• Respect – We value and respect each patient, their family, ourselves, and each other. Every individual associated with Johnson Health Center will be treated with dignity and respect. We value and respect people’s differences, show empathy to our patients, their families and each other, and work collectively to build Johnson Health Center as a health center and an employer of choice.
• Integrity – We are committed to doing the right thing every time. Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical behavior. We are accountable for the decisions we make and the outcome of those decisions.
• Excellence – We will pursue excellence each and every day in activities that foster, teamwork, quality improvement, patient care, innovation, and efficiencies. At Johnson Health Center, our medical, dental, pharmacy, behavioral health, front desk and administrative teams are passionately committed to the highest quality of care for our patients. We continually seek out ways to enhance the patient experience and promote an environment of continuous quality improvement.
• Innovation – We value creativity, flexibility, and continuous improvement efforts. We are advocates and instruments of positive change, encouraging employees to engage in responsible risk-taking and working to make a difference. Out of the box thinking enables us to build on successes and learn from failures.
• Teamwork – We understand that teamwork is the essence of our ability to succeed. We work across functional boundaries for the good of the organization. Our collaborative approach ensures participation, learning and respect and serves to improve the quality of patient care.