Sr. Credentialing Specialist

Department/Unit:

Medical Staff Credentialing

Work Shift:

Day (United States of America)

Salary Range:

$55,895.80 - $83,843.71This position supports the Albany Med Health System (Affiliates) Medical Staff Office and the Centralized Verification Office (CVO) and will be located at Columbia Memorial Hospital. Evaluates, analyzes, and coordinates all aspects of the Medical Staff and Delegated Credentialing and Re-Credentialing processes for practitioners practicing within the Albany Med Health System & its Affiliates. Will serve as a liaison between internal clients and functional department including Albany Med Health System's ongoing auditing & monitoring of credentials files.

Essential Duties and Responsibilities

• Gathers and synthesizes data for Department Chairs applicants
• Participates in System wide Credentialing Committee
• Participates in Medical Staff Credentialing Committee
• Actively participates in planning and improving application Process Metric
• Ensure through audits that the Albany Med Health System's programs are consistently administered in compliance with Albany Med Health System and organizational policies and procedures, delegation and contractual obligations, rulings, laws, and government regulations
• Assists with onboarding and training of new credentialing associates
• Expertise with NCQA Credentialing Standards, Compliance
• Familiarity with Managed Care Health Insurance Plans, credentialing, and enrollment procedures

Qualifications

• Associate's Degree - required
• Bachelor's Degree in Business Administration or related field - preferred
• 4-6 years experience in Medical Staff, Medical Staff Operations or Managed Care credentialing - required
• Proficiency in MSOW, credentialing software database preferred
• Strong Interpersonal, communication, organizational skills (extensive work and collaboration with other organizations)
• Ability to work effectively and cooperatively with both internal and external individuals, departments, and agencies
• Able to communicate effectively at all levels within the organization and with external customers and agencies.
• Creates a collegial and collaborative environment among all members of the healthcare team.
• Demonstrates responsibility and accountability for decisions.
• Identifies problems, gathers data, establishes facts, and draws valid conclusions.
• Possesses knowledge of quality concepts, principles, and problem-solving tools and techniques and demonstrates ability to apply in support of departmental process and quality improvement.
• Credentialing Verification Office, Payer credentialing experience a plus.
• Knowledge of TJC requirements in conjunction with credentialing principles
• Ensures compliance with the accrediting agencies (i.e., NCQA, JCAHO, NYS DOH, NYS DOE, CMS and Federal laws)
• Certified Provider Credentialing Specialist (CPCS) Upon Hire - preferred
• Certified Medical Professional Services Management (CPMSM) Upon Hire - preferred

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Working Conditions

• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Hazards - Rarely
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Thank you for your interest in Albany Medical Center!​

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.