Credentialing Specialist

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering exceptional health care. Come join us at ChristianaCare

ChristianaCare is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as the Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care. ChristianaCare is shaping the future of health care

ChristianaCare Offers

• Full Medical, Dental, Vision, Life Insurance, etc.
• Two retirement planning offerings, including 403(b) with company contributions.
• Generous paid time off with annual roll-over and opportunities to cash out.
• 12-week paid parental leave
• Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more.

About This Position

ChristianaCare is searching for a Credentialing Specialist to provide support for medical staff activities to ensure that credentialing, privileging, and other important functions are performed in accordance with the Medical-Dental Staff governance documents, CMS, The Joint Commission, and other rules as mandated by state and federal regulations. This includes conducting, maintaining, reviewing the credentialing, privileging, and primary source verifications for ChristianaCare providers. The Credentialing Specialist serves as a resource and collaborator with others in the Medical-Dental Staff Office and the Credentials Verification Organization (CVO).

This position is 100% in-office. Please only apply if you are looking for an in-office position.

Principal duties and responsibilities:

• Coordinates and verifies the accuracy of all credentialing/privileging functions for assigned departments to include the support of the department’s credentials committee, agenda preparation, minute taking, and the review and oversight of initial appointments and re-appointments.
• In collaboration with the Department Chairs, provides ongoing assessment and modification of privileging forms to ensure the consistency and standardization of the privileging processes.  Manages change in privilege process in coordination with department and CVO.
• In collaboration with Manager and Corporate Director, coordinates and supports select committees of the medical-dental staff (ad hoc and special committee meetings) to include the development of agendas and minute taking.
• Follows the established departmental workflows and processes, including but not limited to waiver requests, license/board certification expiration, management of application for compliance with Medical Staff Bylaws and regulatory requirements. In collaboration with CVO, monitor monthly licensure for (state(s), CSR, DEA), new applicant reconciliation and audits, (licenses, NPDB enrollment) and renewal reconciliation (appropriate dates, license verification). Compiles quality data/logs for initial and reappointments.
•  The Credentialing Specialist is expected to respond in a timely manner to all internal and external data requests.  All departmental processes, as outlined in the ChristianaCare Credentials Manual and governance documents will be followed.   Familiarity with OPPE and FPPE processes preferred.
• Send and review pre-application to providers requesting privileges. Submit application requests to CVO including copy of CV. Complete background screening and state mandatory requirements for non-employed providers, as required. Tracks status of applications and maintains ongoing communication with CVO throughout the credentialing and recredentialing process. Completes final file review to ensure complete file prior to review by department.
• Familiarity with OPPE and FPPE processes to ensure processes are aligned with The Joint Commission and CMS Conditions of Participation.  
• Performs other related duties as required.

Education and experience requirements:

Associate’s degree or equivalent required. Bachelors’ degree in healthcare related field preferred. An equivalent combination of education and experience may be substituted.

A minimum of two years’ work-related experience is preferred. Credentialing experience should include a combination of activity coordination and exposure to regulatory bodies such as The Joint Commission and CMS.

Additionally, the Credentialing Specialist will be required to obtain certification as a Certified Provider Credentialing Specialist (CPCS) within 5 years of eligibility or within 1 year after reaching exam eligibility if new to ChristianaCare. This requirement is preferred if the candidate has been working as a Credentialing Specialist with greater than 15 years’ experience in this profession.