Credentialing Specialist

Job Summary

The Credentialing Specialist independently manages complex credentialing and privileging activities for medical staff and advanced practice professionals at UC Davis Health. They apply advanced knowledge of credentialing and privileging theory, regulatory requirements, medical staff policies, and applicable standards to evaluate the clinical qualifications of providers and ensure practitioners are appropriately credentialed and privileged.

Responsibilities

• Evaluate and process applications and supporting documentation for medical staff and advanced practice professionals
• Serve as the primary liaison for applications presented to the Credentials and Privileges Committee, Medical Staff Executive Committee, and Governing Body
• Manage the full range of credentialing and privileging activities, including recredentialing, ongoing monitoring, and documentation
• Provide technical expertise related to the Credential Stream credentialing database
• Represent UC Davis Health as a credentialing and privileging professional during reviews and inquiries conducted by regulatory, accrediting, governmental, health plan, and University entities

Requirements

• Completion of applicable NCQA credentialing education/training or equivalent demonstrated experience and knowledge of NCQA credentialing standards
• Several years of experience in medical credentialing or similar equivalent roles
• Experience applying NCQA credentialing standards and credentialing-integrity requirements in practitioner credentialing, primary-source verification, recredentialing, ongoing monitoring, documentation, and audit readiness
• Knowledge and understanding of Credentialing and Privileging principles and theories
• Critical thinking, research, investigatory, and analytical skills to solve problems and propose solutions through the critical thinking process
• Knowledge and skills to assess and monitor credentialing theory, compliance, and effectiveness of credentialing and privileging processes
• Knowledge of medical terminology and medical and surgical procedures
• Skills to independently set and meet deadlines while multitasking, assigning precedence to competing priorities, to see multiple assignments through to completion on deadline and according to organizational goals
• Skills to work collaboratively
• Skills to coordinate and integrate with others throughout the department, hospital, and campus
• Skills to communicate through all mediums and with all groups; often working under pressure of constantly changing deadlines and priorities
• Excellent verbal and written communication skills
• Thorough knowledge of data management and documentation methods used in medical credentialing
• Demonstrated computer and database knowledge, along with MS Office proficiency and ability to effectively use the credentialing database application

Qualifications

• Minimum Qualifications: Several years of experience in medical credentialing or similar equivalent roles, experience applying NCQA credentialing standards and credentialing-integrity requirements in practitioner credentialing, primary-source verification, recredentialing, ongoing monitoring, documentation, and audit readiness, knowledge and understanding of Credentialing and Privileging principles and theories, critical thinking, research, investigatory, and analytical skills to solve problems and propose solutions through the critical thinking process, knowledge and skills to assess and monitor credentialing theory, compliance, and effectiveness of credentialing and privileging processes, knowledge of medical terminology and medical and surgical procedures, skills to independently set and meet deadlines while multitasking, assigning precedence to competing priorities, to see multiple assignments through to completion on deadline and according to organizational goals, skills to work collaboratively, skills to coordinate and integrate with others throughout the department, hospital, and campus, skills to communicate through all mediums and with all groups; often working under pressure of constantly changing deadlines and priorities, excellent verbal and written communication skills, thorough knowledge of data management and documentation methods used in medical credentialing, demonstrated computer and database knowledge, along with MS Office proficiency and ability to effectively use the credentialing database application
• Preferred Qualifications: Certification as a CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional in Medical Services Management), Completion of NCQA credentialing education/training applicable to the organization's credentialing program, Experience maintaining documentation and audit trails sufficient to support NCQA accreditation/certification and internal credentialing audits, Knowledge of credentialing integrity and compliance practices, including maintaining accurate, complete, current, and confidential practitioner credentialing records, Ability to identify credentialing discrepancies, gaps, and compliance issues and ensure timely resolution