Credentialing Specialist
2 months ago
**About NYC Health + Hospitals**:
**Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible**
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Under general supervision, with some latitude for independent judgement and initiative, assists and acts in a confidential capacity to health care setting and system leadership in matters directly involving personnel, labor relations, risk management, quality and safety, and compliance.
Utilize, administer, and maintain a centralized secure database which holds confidential data used to facilitate a vetting process that ensures compliance with hiring and quality of care standards. Data gathered includes, but is not limited to licensure, controlled substance prescription certification, education and training, specialty board certification, background checks and medical malpractice history. Perform sanction queries related to practitioners’ history for fraud, illegal dispensing and distribution of controlled substances, and patient abuse or neglect.
Liaise, work closely with and assist labor relations, office of legal affairs, human resources, risk management, compliance, healthcare governance, quality and safety, and Epic/EMR security departments, who rely on information gathered and vetted during the medical staff and allied health professional’s appointment, reappointment and privileging process, to fulfill their respective responsibilities.
General tasks and responsibilities will include:
- Create and maintain all routine and ad-hoc credentialed provider reports which may contain confidential and sensitive data
- Assist in the overall maintenance of the corporate wide credentialing database which may include installation of software upgrades and patches
- Generate credentialing reports to facilitate clinical initiatives within our healthcare system
- Troubleshoot, facilitate, and liaise with outside vendors to resolve technical issues and system outages
- Utilize Enterprise Learning Module (ELM) to enroll credentialed providers in moderate and deep sedation training and other training modules, as required, based on clinical privileges requested by provider
- Credentialing Standards: maintains consistency in database entry to ensure accurate and consistent processes
- Database records management: Ongoing monitoring and management of assigned provider credentialing profiles, which includes but is not limited to:
- Investigating and validating malpractice and adverse information obtained
- Ensuring licensure and competency is current and meets regulatory standards
- Data quality/audit management
- Utilizes database status/alert and other report functions, software tools and links to scanned documentation
- Credentialing: Responsible for all aspects of provider credentialing and recredentialing
- License Renewals: Ensures that physician licenses are renewed prior to expiration
- Primary Source Verification: Completes primary source verification for new and existing providers to ensure due diligence
- Facilitate the centralized Governing Body approval process
- Participate in department meetings and periodic training sessions
- Back-up Coverage: provide credentialing back-up for other members of the credentialing group
- All other assignments as needed
**Minimum Qualifications**:
1. A Baccalaureate Degree from an accredited college or university in Public Health, Public Administration, Business Administration, Social Work, Psychology or Rehabilitation Counseling, and three years of full-time experience in medically oriented health care and medical support systems environment, two years of which included experience in an administrative or supervisory capacity in such occupations as physical, occupational, inhalation, speech and audiology therapy or as Medical/Laboratory Technologist, Microbiologist (various specialties), Chemist (biochemist), Radiation and X-Ray Technician or three years of responsible level experience in business management systems or general administration including two years in a supervisory or administrative capacity.
2. A Masters Degree from an accredited college or university in the disciplines listed in (1
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