Specialist, Credentialing

Description

POSITION SUMMARY
The Credentialing Specialist is responsible for all aspects of the initial credentialing, re-credentialing, privileging and overseeing the credentialing portion of the new hire on-boarding process for all incoming Physicians, Nurse Practitioners and Physician Assistants. Responsible for the application process which includes maintenance of the online application site and forms repository and intake, review and appropriate routing of all credentialing documents. Responsible for the insurance/billing and facility credentialing. This position liaises with both internal and external agencies involved in the credentialing process. Also liaises with programs, hospitals and applicants regarding any required follow up or notification. 

In addition to credentialing of providers, position will maintain certifications, licenses, DEAs and CMEs for medical staff.

Work is typically performed in an office environment, but this position has the option to work from home with participation in customer/community services activities as needed. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

ESSENTIAL JOB DUTIES AND FUNCTIONS

While living and demonstrating our Core Values, the Credentialing Specialist will:

• Maintain credentialing and competency files in an orderly and current manner
• Appropriate boards and certifying agencies are contacted to assure current and accurate information is maintained on an ongoing basis
• Documents are filed timely and accurately in the credentials and competency files
• Data is entered in the credentialing management system timely and accurately
• Prepare information for Credentialing review
  • Ensure credential file is in order with any issues of concern flagged
  • Assist with research and preparation of documents to support development of clinical privilege criteria
  • Prepare for internal and external audits conducted for current and accurate provider information
• Assist with projects related to credentialing and privileging functions and maintains institutional tracking system of privileges
  • Review and interprets applicable accreditation, licensure, and other regulatory requirements to ensure the organization's bylaws and policies meet requirements.
  • Design and update forms and checklists, including but not limited to, application forms, clinical privilege documents, checklists, etc.  
• Maintain confidentiality of credentialing information
  • Release of confidential credentialing information is limited to persons in a need/right to know position.
• Maintain certifications (ACLS, BLS, PALS. Etc.), CMEs, Licenses and DEAs for all Faculty and clinical staff
• Improve professional growth and knowledge related to job-specific competencies. 
• Independently seeks out and utilizes information resources
• Participates in the design, implementation, and ongoing management of performance improvement activities
• Demonstrates commitment to continuous performance improvement

Requirements

REQUIRED QUALIFICATIONS

• Bachelor’s degree or equivalent experience 
• Minimum 5 years of experience working in a medical facility environment or healthcare background
• Working knowledge of medical terminology, insurances and billing
• Experience with electronic medical records
• Excellent communication skills in one-on-one interactions, electrically and over the phone
• Ability to perform the role successfully in a high-intensity environment
• Strong computer skills specifically Microsoft Excel
• Must be a time driven individual who can meet many deadlines with a variety of outside parties
• Must be extremely organized and successfully monitor the status of many concurrent deadlines
• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
• Buy in and experience working in the EOS® model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride