Credentialing Specialist - Medical Staff Office - FT - Day

Schedule:

Full time - 36 hours/week or greater

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Weekly Work Schedule:

8-4:30, M-F
Job Information
Exemption Status: Non-Exempt

A Brief Overview
This Credentialing Specialist will assist in ensuring patient safety throughout Stormont Vail Health. This position works with the Medical Staff and Administration ensuring Stormont Vail Health (SVH), SVH Bylaws and other regulations are met through the medical staff and organizational processes. The Credentialing Specialist is responsible for communicating information to the Director, Credentialing Coordinator, Medical Staff and others as appropriate.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred
• Bachelor's Degree Preferred

Experience Qualifications

• 4 years Experience in the field of primary source verification credentialing in a healthcare environment or equivalent experience performing administrative duties with a clinical focus Required
• 3 years Experience with Microsoft office products including but not limited to; Excel, Word, and PowerPoint. Required
• 3 years Prior health care industry experience. Preferred
• 1 year MD-Staff, MD-Stat experience. Preferred

Skills and Abilities

• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, legal, accrediting and regulatory information and medical terminology. (Required proficiency)
• Ability to analytically think. Ability to perform clinical competence evaluations. Able to be flexible and adaptive to timelines and situations. Knowledge of change or database management. Ability to ask questions and to follow instructions/directions. (Required proficiency)
• Confidentiality, Foster team cohesiveness and collaboration & Professional Ethics. Able to build relationships. (Required proficiency)
• Demonstrate excellent writing skills to develop and write business correspondence, reports and procedure manuals accurately and in accordance with recognized standards (grammar, punctuation) for the English language. (Required proficiency)
• Demonstrates respect for all individuals (visitors, peers, customers and team members) and helps create and maintain teamwork within the work environment, which contributes to meeting the goals and objectives of the Medical Staff Services department and reflects the mission and values of Stormont Vail Health. (Required proficiency)
• Exhibit oral communication skills (tact, diplomacy etc.) to represent and respond to information for a broad audience including, but not limited to, managers, physicians, outside regulatory agencies, customers and the public. (Required proficiency)

Licenses and Certifications

• Certified Provider Credentialing Specialist - NAMSS CPCS also accepted. Preferred
• CPMSM is preferred.

What you will do

• CONDUCTS, PARTICIPATES IN, AND MAINTAINS PRIMARY SOURCE VERIFICATION: Perform outreach to primary sources for practitioners’ information. Obtain and evaluate information from primary sources. Perform detailed and thorough review of applications, primary source verifications, and sources provided. Recognize potential discrepancies and adverse information, and independently investigate and validate information from primary source verifications, or other sources. Verify and document expireables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Serve as main point of contact for external queries regarding practitioners’ status, providing responses in a timely matter.
• Compile practitioner sanctions, complaints, and adverse data to ensure compliance. Demonstrate an understanding of state and regulatory standards. Demonstrate an understanding of state and regulatory standards in relation to telehealth and credentialing by proxy.
• Complete evaluation of application to determine applicant’s initial eligibility for membership/participation. Review application and supporting documents for completeness. Serve as main point of contact for practitioner during application process, providing timely updates and additional information as requested. Determine applicant’s initial eligibility for membership/participation based on approved criteria. Compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies. Perform initial or reappointment/re-credentialing for eligible practitioners. Process requests for privileges. Conduct, participate in, and maintain credentialing verification organization (CVO)
• Identify and repor