Medical Staff Credentialing Specialist

The Centralized Credentialing Specialist processes practitioner applications for initial appointments and/or reappointments by following The Joint Commission (TJC), National Committee for Quality Assurance (NCQA) and other State Regulatory requirements. Thoroughly reviews and evaluates applications. Identifies extraordinary information, discrepancies, time gap and obtains additional explanation and information as required. Plays a proactive role in process improvement. 

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Centralized Credentialing Specialist Job Responsibilities:

• Processes practitioner applications for initial appointment and/or reappointments.
• Manages, supports and maintains credentials files on all medical staff members and advanced practice providers. Consults and works with other hospital departments to coordinate process.
• Assures compliance with regulatory requirements and accrediting body standards, Bylaws and policies. Consistently reviews regulatory requirements, accrediting body standard, Bylaws and policies to maintain current knowledge.
• Initiates and processes application with thorough review and evaluation.
• Plays a proactive role in improving processes within the department for maximum efficiency by participating/leading process improvement activities.
• Communicates status of application to practitioners and all interested parties.
• Appropriately identifies and escalates extraordinary information, time gaps and potential discrepancies and adverse information, and independently investigates and validates information on applications, primary source verifications or other sources.
• Conducts follow-up and research regarding additional required information. Documents appropriately.
• Manages, supports and maintains the Network Insurance Credentialing process for appropriate employed practitioners.
• Completes audit updates on Network Insurance files

Centralized Credentialing Specialist Requirements:

• Education: High School diploma or equivalent
• Experience: 1 year of experience in healthcare setting or customer service; or, BA degree and no experience.

Centralized Credentialing Preferred Requirements:

• Experience in credentialing, preferably in a centralized credentialing environment or within a healthcare facility such as a hospital or medical group.
• Knowledge of medical terminology and healthcare operations.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) with strong data entry and reporting skills.
• Excellent verbal and written communication skills, with the ability to interact professionally with providers, leadership, and external organizations.

 

 

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 25,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. 

Inova Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.