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Credentialing Specialist I
3 months ago
Verifies medical training, experience and other attributes required of medical health care providers. Ensures the completion of files and monitors expired documents during the members’ appointment period. ESSENTIAL FUNCTIONS: Coordinates, monitors and maintains the credentialing and recredentialing process. Reviews applications and other data for accuracy and completeness. Performs primary source verification of initial and reappointments applications by preparing requests for information letters, tracking responses and follow-up for needed information. Obtains licensure, insurance and other certificates at time of reappointment or as they expire and enters them in our database. Enters accurate and up-to-date data for each applicant into the database and responds to verification requests. Ensures the accuracy of documentation to support the request for privileges by maintaining good working relationships with clinical departments, Medical Staff leadership and professional agencies. Assists in compliance with the accrediting and regulatory agencies in regards to credentialing, while developing and maintaining a working knowledge of the required statutes and laws. Answers phones, makes copies, prepares mailings and maintains files. Assists with timely maintenance and accuracy of database. Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards. Performs related duties as assigned. MINIMUM QUALIFICATIONS EDUCATION: High school diploma or general education degree (GED), or an equivalent combination of relevant education and experience. EXPERIENCE: Two (2) years experience performing medical staff credentialing. LICENSURE OR CERTIFICATION: None required KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of what credentialing of medical health care providers entails.
- Knowledge of all regulations, statues and laws as it relates to documents required for credentialing.
- Skill in organizing processes and procedures and maintaining files.
- Skill in prioritizing tasks to ensure time sensitive files are carefully handled without delaying processes and procedures.
- Skill in adjusting assignments due to interruptions without unduly impacting work flow.
- Skill in preparing and presenting information for management, employees, and general public.
- Skill in the use of Microsoft Office products, especially Word and EXCEL.
- Ability to review and monitor various forms and detailed information to ensure compliance with procedures and individual candidates expectations for membership.
- Ability to read, analyze, and interpret detailed forms, general business periodicals, professional journals, technical procedures, or governmental regulations.
- Ability to write reports, business correspondence, and procedure manuals.
- Ability to respond to inquiries or complaints from employees, patients and/or their representatives and the general public.
- Ability to add, subtract, multiply, and divide using whole numbers, common fractions and decimals.
- Ability to define problems, collect data, establishes facts, and draw valid conclusions.
