Credentialing Specialist

Job DescriptionJob DescriptionPosition Summary
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

Safety/Infection Control
 

• 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.

Performance Improvement
 

• Participate in performance improvement activities as necessary

Customer Service

• 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.

Emergency Center Policy
 

• 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

QualificationsEDUCATION & EXPERIENCE

• 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

LANGUAGE/MATH/REASONING ABILITY

• 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

COMPUTER SKILLS

• Proficient computer skills

CERTIFICATE/LICENSES

• 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,

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

JOB DESCRIPTION
 

• 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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