Medical Staff Credentialing Specialist

3 weeks ago

Alexandria, United States River Hospital Inc Full time
We are seeking a detail-oriented and highly organized Medical Staff Credentialing Specialist to become an integral part of our dynamic healthcare team. This crucial position involves maintaining accurate records, ensuring compliance with regulatory standards, and facilitating the credentialing and recredentialing processes for our medical professionals. If you are passionate about upholding the highest standards of patient care through meticulous credential management, we encourage you to apply.

Job Responsibilities
  • Review and process credentialing and recredentialing applications for medical providers.
  • Verify medical staff credentials, including licenses, certifications, education, and training.
  • Maintain up-to-date knowledge of regulatory requirements and accreditation standards related to credentialing.
  • Ensure compliance with federal and state laws, as well as hospital bylaws and policies regarding medical staff credentialing.
  • Conduct thorough background checks, including querying the National Practitioner Data Bank (NPDB).
  • Collaborate with medical staff leadership and committees to review and assess credentialing files.
  • Manage the credentialing database to ensure information is accurate and current.
  • Respond to verification requests and communicate credentialing status to relevant departments.
  • Prepare and maintain detailed reports regarding credentialing and recredentialing activities.
  • Assist with the development and implementation of credentialing processes and procedures.
  • Coordinate with other departments to resolve any discrepancies or issues related to credentialing.
  • Participate in audits and reviews to ensure the integrity of the credentialing process.
  • Facilitate ongoing provider credentialing education and training for staff and providers.
  • Serve as a liaison between the medical staff and administration on credentialing matters.
  • Maintain strict confidentiality of provider information in accordance with HIPAA regulations.
Job Requirements
  • Associates degree in healthcare administration, human resources, business administration, or related field
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred
  • Minimum of 2 years of experience in medical staff services or credentialing in a healthcare setting
  • Proficiency with credentialing databases and software
  • Knowledge of national and state regulations, as well as accreditation standards related to credentialing (e.g., Joint Commission, NCQA, CMS)
  • Strong attention to detail and ability to maintain accurate and complete credentialing files
  • Excellent organizational and time-management skills
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, Teams)
  • Ability to handle sensitive information with discretion and maintain confidentiality
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team
  • Familiarity with medical terminology and healthcare provider licensure requirements
  • Demonstrated ability to follow up on pending issues with persistence and determination
  • Experience conducting primary source verifications
  • Ability to multitask and meet strict deadlines
  • Commitment to continuous professional development and keeping current with best practices in credentialing
  • Customer service-oriented with the ability to interact

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