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Credentialing Specialist
3 months ago
Job Summary
The NCPS Credentialing Specialist is an integral part of the NCPS physician group, collaborating closely with Medical Staff Offices (MSOs) at Nicklaus Children's and external affiliate hospital credentialing teams. Provides exceptional customer service to physicians, advanced practitioners, internal and external staff by efficiently facilitating the processing of credentialing applications and files. Plays a crucial role in facilitating and assisting in the processing and vetting applications submitted by healthcare professionals, ensuring compliance with relevant standards and regulations, and contributing to the successful integration of clinicians in community affiliate hospitals.
Responsible for interacting with key stakeholders in the telehealth credentialing and training process for the planning, promoting and supporting of telehealth operations, programs, and services. Responsible for interacting with physicians and advanced practitioners to facilitate and optimize the data collection and application processes of affiliate hospitals. Develops and fosters communication and relationships with internal and external customers to promote improved access to virtual care services, community hospital privileging, and continued compliance.
Job Specific Duties
- Coordinates and manages the credentialing process for new and existing healthcare providers, within the system and external affiliations. This includes communicating with the provider, obtaining new and/or updated data necessary for the completion of applications, and submitting applications to credentialing bodies.
- Prepopulates clinician new and re-credentialing applications accurately as needed. Collects and verifies information, including licenses, certifications, and professional references.
- Promptly and accurately reviews clinician applications to ensure compliance with internal and external affiliate hospital standards, regulatory and other requirements. Responsible for ensuring that all credentialing and privileging activities comply with regulatory and accreditation requirements. This includes maintaining knowledge of current regulations, credentialing and privileging policies and procedures, and. other accreditation requirements and industry standards.
- Responsible for maintaining accurate and up-to-date records in electronic credentialing databases and other systems. Verifies and maintains provider information and ensures that all provider information, including licensure, education, training, and certification, is accurate. This includes entering data, updating records, and may involve contacting licensing boards, educational institutions, and other organizations to verify credentials.
- Monitors and tracks expiring credentials at other affiliate hospitals to ensure timely renewals. This involves notifying providers of upcoming expiration of privileges and following up to ensure that renewals are completed.
- Collaborates with internal and external stakeholders and MSO’s at affiliate organizations to provide required credentialing information, supporting documents.
- Maintains open communication with the credentialing teams and all stakeholders throughout the credentialing process. Communicates with clinicians and hospitals to resolve any credentialing issues or discrepancies.
- Completes assigned work within specified timelines, ensures timely completion of credentialing tasks, proactively communicates progress and issues to relevant parties. Holds self-accountable for understanding and resolving problems, issues, and provides options for resolutions.
- Delivers high-quality outputs consistent with expectations, maintains accurate and up-to-date credentialing files and provides regular updates to leadership.
- Develops and maintains relationships with key stakeholders and works closely with healthcare providers and external organizations to facilitate the credentialing process. This may involve developing and maintaining relationships with providers, insurance companies, and regulatory bodies.
- Provides support and guidance to healthcare providers and internal stakeholders on matters related to credentialing and privileging. This may involve answering questions, providing training, and addressing concerns or issues related to the credentialing process.
- Participates in quality improvement activities related to credentialing and privileging processes. This may involve analyzing data and identifying areas for improvement, as well as developing and implementing process improvements.
