Credentialing Specialist - Medical Administration * Days (M-F, 8am-5pm) - 40hrs/wk

Credentialing Specialist - Medical Administration * Days (M-F, 8am-5pm) - 40hrs/wk

Requisition #: req12385

Shift: Days

FTE status: 1

On-call: No

Weekends: No

General Summary:

Perform credentialing and re-credentialing activities for all physicians and allied health providers.  Preparation of meeting agendas, minutes and other departmental correspondence, as required.

Requirements:

• High School Diploma required, Bachelor’s degree preferred
• CPCS certification preferred
• 1-3 years of experience in credentialing and privileging, preferred
• Proficient in Microsoft Office Word, PowerPoint, Excel and Credentialing Software
• Excellent oral and written communication skills
• Excellent customer service ability

Essential Functions and Responsibilities:

1. Accountable for all credentialing and re-credentialing activities for physicians and allied health providers. Duties include, but are not limited to:
   1. Collection, scanning and processing of all new provider applications and reapplications. This includes but is not limited to processing criminal background checks, state licensure checks, National Practitioner Data Bank checks, peer reference forms, privileging, hospital verification forms, and primary source verifications.
   2. Data entry into credentialing software program.
   3. Preparation of files to be sent to Credentials Committee.
   4. Preparation of meeting agendas and minutes as required.
2. Present complicated information with regard to credentialing, re-credentialing and privileging to section chief, department chair and/or Credentials Committee.
3. Assist with credentialing audits and preparation for regulatory agency reviews.
4. Generate all department reports and lists as requested.
5. Provide orientation for providers (tour of hospital, review of policies, ID badge and other orientation duties).
6. Serve as primary data entry point/gatekeeper for departmental forms and reports
7. Serve as a department liaison for OMM Department.
8. Assist with General Staff and Physician meetings.
9. Processing of incoming department mail, requests, and verifications.
10. Maintenance of monthly expired credentials list (insurance, DEA and licensure for physicians and AHPs), annual dues, and forms.
11. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.