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Credentialing Specialist
3 weeks ago
The Credentialing Specialist will be responsible for performing all functions necessary to maintain the efficient workflow of the Medical Staff Office and credentialing specialist responsibilities.
Essential Duties & Responsibilities
- Manage the credentialing process for healthcare providers, including physicians, Midlevel practitioners, Locum Tenens applicants, and other licensed medical providers.
- Verify the accuracy and completeness of provider credentialing applications, ensuring that all required documents are submitted.
- Conduct thorough background checks, license verifications, and references to ensure compliance with regulatory standards.
- Coordinate with internal departments and external agencies to obtain and update relevant provider information.
- Maintain accurate and up-to-date electronic and hard copy files of all credentialing documentation.
- Communicate with providers to address any discrepancies or missing information.
- Monitor expiring licenses and credentials, proactively initiating the renewal process to avoid any disruption in services.
- Assists in the reappointment process for all medical staff categories.
- Update each provider's CAQH database file timely according to the schedule published by CMS
- Maintain internal provider roster and ensure all information is accurate and provider logins are available.
- Stay up-to-date with industry regulations and requirements, ensuring compliance at all times.
- Assists in preparation for CIHQ Survey working closely with the Medical Staff to ensure compliance with standards.
- Provide support and guidance to internal staff regarding credentialing and privileging processes.
- Assist with distributing meeting calendar to department managers and active medical staff members. Attends and takes minutes for the Medical Executive Committee.
- Prepares agenda, information packets, and coordinates arrangements for the Credentials Committee; notifies participates of meeting.
- Maintains databases, preparing reports routinely
- Maintains confidentiality and appropriate handling of PHI
- Performs all other related duties as required and assigned
- Demonstrate knowledge of and adhere to regulations and Exceptional Healthcare policies and procedures pertaining to safety, emergency preparedness, infection control, OSHA, fire safety, and hazardous materials.
- Participate in performance improvement activities as necessary
- Maintain confidentiality of patient-related issues and adhere to all Credentialing Specialist rules and regulations.
- Demonstrate effective interpersonal skills
- Treat all patients, visitors, and staff members fairly and with respect
- Utilize effective communication methods and skills
- Explain all procedures, treatments, and care while remaining aware of language barriers
- Able to perform care in a non-judgmental manner and recognize discrepancies between patient and personal beliefs.
- Ensure personal appearance is professional at all times and adheres to dress code
- Responsible for wearing an Exceptional Healthcare identification badge at all times which must be visible and above the waistline
- Attend all Exceptional Healthcare required meetings and in-service education
- Remain flexible in staffing patterns and resolution of staffing conflicts; participates in temporary assignments
- Compliance with attendance standards
- Demonstrate flexibility when changes in assignments are necessary
- High School Diploma or GED Certificate
- Bachelor’s degree in healthcare administration, business, or a related field (preferred)
- Minimum of 2 years of experience in credentialing or provider enrollment
- Strong knowledge of industry regulations, such as the Center for Improvement in Healthcare Quality (CiHQ)
- Proficient in using credentialing software and databases for data entry and maintenance
- Excellent attention to detail and ability to work with complex documents
- Exceptional organizational and time management abilities
- Effective communication and interpersonal skills
- Ability to work independently and collaboratively within a team
- Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization
- Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations
- Proficient computer skills
- Preferred certification from NAMSS, NAPCS, AAHQ, etc.
- Professional Maturity: The ability to separate emotional feelings from the real issues at hand
- Responsibility: The ability to accept choices you have made and the results they have led to
- Communication: The ability to write and speak effectively; actively listens to others, and give feedback
- Flexibility: Demonstrate responsiveness and adaptability following change initiatives
- Intelligence: Understand information and apply new knowledge
- Energetic: Exhibits high levels of energy and enthusiasm
- Organized: Efficient in structuring tasks to be accomplished
- Computer Savvy: The ability to use technology efficiently and effectively.
Competencies
- Customer Service: The ability to enhance customer satisfaction
- Job Knowledge/Technical Knowledge: Knowledgeable of the current role and technical systems, and the impact it has on the organization
- Integrity and Respect: Demonstrates the utmost level of integrity
- Interpersonal Communication: Writes and speaks effectively based on the psychological,
- Collaboration and Partnership: Encourages participation from team members
- Manages Change: Demonstrates flexibility with changing environments
- Problem Solving: Resolve issues in a timely manner
- Attention to Detail: Follows procedures to ensure entry of data
- Organization: Uses time efficiently by prioritizing and planning work activities
- Judgment: Ability to make independent decisions
- Teamwork: Works with others to accomplish objectives and shows support for decisions
- Quality: Sets high standards to ensure quality in work performed
- Accountability: Takes responsibility for adhering to all company policies, procedures, and performance expectations
- Customer Service: The ability to enhance customer satisfaction
- Job Knowledge/Technical Knowledge: Knowledgeable of the current role and technical systems, and the impact it has on the organization
- Integrity and Respect: Demonstrates the utmost level of integrity
- Interpersonal Communication: Writes and speaks effectively based on the psychological, the relational, situation, environmental, and cultural dynamics within the situation.
- Collaboration and Partnership: Encourages participation from team members
- Manages Change: Demonstrates flexibility with changing environments
- Problem Solving: Resolve issues in a timely manner
- Attention to Detail: Follows procedures to ensure entry of data
- Organization: Uses time efficiently by prioritizing and planning work activities
- Judgment: Ability to make independent decisions
- Teamwork: Works with others to accomplish objectives and shows support for decisions
- Quality: Sets high standards to ensure quality in work performed
- Accountability: Takes responsibility for adhering to all company policies, procedures, and performance expectations
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