The Credentialing Specialist performs the credentialing processes for all initial applications and reappointments in a timely and complete manner. They are able to collect and verify sensitive provider data through confidential sources and maintain a credentialing database. They perform relevant data entry into the database to ensure consistency and integrity of the data. They also perform analysis and appropriate follow-up of each initial application and reappointment application. They process appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and are required to maintain documentation in the database. They are responsible for preparing and maintain files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets for Medical Staff leadership to review for presentation to the department chairman and credentials committee as well as attending medical staff meetings. The Credentialing Specialist has knowledge of commonly used concepts, practices, and procedures within medical staff services. They will work independently utilizing the pre-established guidelines, Medical Staff Bylaws, Rules and Regulations, MQA Credentialing plan and policies to ensure all accreditation requirements, NCQA standards, state and federal requirements are maintained.

SHIFT AND SCHEDULE

Full Time: 8:00 AM – 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Responsible for initial processing and maintenance of the files of all individuals who are permitted by the law and by the hospital to provide patient care services independently and who have clinical privileges, whether or not they are members of the medical staff; initiation of the reappointment process of medical staff and reappraisal process of allied health professionals.
• Maintaining and modifying the physician and allied health professional data base; development and production of reports pertaining to the medical staff provision of support, as needed, to the medical staff office.
• Responsible for assisting with the facilitation of medical staff meetings and completion of accurate minutes.
• Assists in the coordination of physician and allied health professionals activities in accordance with Bylaws, DNV and other regulatory standards.

EDUCATION AND EXPERIENCE

• High school diploma or GED. An Associate’s degree or equivalent education and work experience is required. Equivalent experience includes two years of hospital credentialing.
• Proficiency in Windows-based word processing and spreadsheet software; basic office equipment familiarity; basic medical terminology; knowledge of basic records maintenance and retrieval systems; and knowledge of DNV requirements for medical staff credentialing and privileging.
• Certified Provider Credentialing Specialist (CPCS) certification from the National Association of Medical Staff Services preferred.
• Demonstrated ability to meet deadlines in a multi-functional task environment with excellent organizational and time management skills and the ability to establish daily work priorities.
• Excellent communication skills, both verbal and written, along with astute judgment in areas of human relations.
• Licensed or willing to obtain license as a notary public.
• Traveling to local Affiliate sites may be required.

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.