Credentialing Specialist

2 weeks ago


New York, United States NavitsPartners Full time
Job DescriptionJob Description

Position: Credentialing Specialist
Location: New York, NY
Duration: 2 Months

Job Description:

We are seeking a detail-oriented and experienced Credentialing Specialist to join our team. The Credentialing Specialist plays a vital role in ensuring the accuracy and integrity of provider credentialing, privileging, and compliance processes. This position requires a thorough understanding of credentialing standards, regulatory requirements, and hospital policies.

Responsibilities:

  1. Facilitate all aspects of provider credentialing, including initial appointment, reappointment, and clinical privileging for Medical Staff, Allied Health Professionals, and other providers as outlined in corporate policies and hospital bylaws.
  2. Utilize MDStaff credentialing software application to perform and monitor all credentialing and background checks, ensuring accuracy and data integrity.
  3. Conduct credential audits to verify compliance with accreditation standards, regulatory requirements, and internal policies.
  4. Interpret and ensure compliance with accrediting and regulatory agencies' standards, including but not limited to The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and Centers for Medicare & Medicaid Services (CMS).
  5. Develop and maintain a working knowledge of statutes and laws related to credentialing, privileging, and provider enrollment.
  6. Collaborate with various departments, including Human Resources, Medical Staff Office, Quality Assurance, and Compliance, to coordinate credentialing activities and ensure timely completion of credentialing processes.
  7. Communicate effectively with providers, hospital staff, and external agencies to obtain required credentialing documentation and resolve credentialing-related issues.
  8. Maintain accurate and up-to-date credentialing files and databases, ensuring confidentiality and security of sensitive information.
  9. Assist in the development and implementation of credentialing policies, procedures, and training programs to promote compliance and efficiency.
  10. Participate in internal and external audits, providing documentation and support as needed to demonstrate compliance with credentialing standards and requirements.

Qualifications:

  1. Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
  2. Minimum of two years of experience in provider credentialing and privileging, preferably in a healthcare setting.
  3. Strong knowledge of credentialing standards, regulations, and accreditation requirements, including TJC, NCQA, and CMS.
  4. Proficiency in using credentialing software applications, such as MDStaff, and Microsoft Office Suite.
  5. Excellent organizational, analytical, and problem-solving skills, with meticulous attention to detail.
  6. Ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines in a fast-paced environment.
  7. Strong interpersonal and communication skills, with the ability to collaborate effectively with internal and external stakeholders.
  8. Commitment to maintaining confidentiality and handling sensitive information with discretion and professionalism.
  9. Willingness to adapt to changes in policies, procedures, and technology to ensure compliance and efficiency.
  10. Certification in Medical Staff Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.


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