Medical Staff Credentialing Professional

3 weeks ago

Alexandria Bay, New York, United States River Hospital Inc Full time
Job Summary

We are seeking a highly organized and detail-oriented Medical Staff Credentialing Specialist to join our dynamic healthcare team at River Hospital Inc. This crucial position involves maintaining accurate records, ensuring compliance with regulatory standards, and facilitating the credentialing and recredentialing processes for our medical professionals.

Key Responsibilities
  • Review and process credentialing and recredentialing applications for medical providers, ensuring timely and accurate completion of the process.
  • Verify medical staff credentials, including licenses, certifications, education, and training, to ensure compliance with regulatory requirements.
  • Maintain up-to-date knowledge of regulatory requirements and accreditation standards related to credentialing, including Joint Commission, NCQA, and CMS.
  • 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), to ensure the integrity of the credentialing process.
  • Collaborate with medical staff leadership and committees to review and assess credentialing files, ensuring accurate and complete information.
  • Manage the credentialing database to ensure information is accurate and current, and respond to verification requests in a timely manner.
  • Prepare and maintain detailed reports regarding credentialing and recredentialing activities, providing insights into the credentialing process.
  • Assist with the development and implementation of credentialing processes and procedures, ensuring compliance with regulatory requirements.
  • Coordinate with other departments to resolve any discrepancies or issues related to credentialing, ensuring seamless communication and collaboration.
  • Participate in audits and reviews to ensure the integrity of the credentialing process, identifying areas for improvement and implementing changes as needed.
  • Facilitate ongoing provider credentialing education and training for staff and providers, ensuring compliance with regulatory requirements.
  • Serve as a liaison between the medical staff and administration on credentialing matters, providing expert guidance and support.
  • Maintain strict confidentiality of provider information in accordance with HIPAA regulations, ensuring the security and integrity of sensitive data.

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, including Microsoft Office Suite.
  • Knowledge of national and state regulations, as well as accreditation standards related to credentialing.
  • Strong attention to detail and ability to maintain accurate and complete credentialing files.
  • Excellent organizational and time-management skills, with the ability to multitask and meet strict deadlines.
  • Ability to handle sensitive information with discretion and maintain confidentiality, ensuring the security and integrity of sensitive data.
  • Excellent written and verbal communication skills, with the ability to interact with medical staff and administration.
  • Ability to work independently and as part of a team, with a commitment to continuous professional development and keeping current with best practices in credentialing.
  • Familiarity with medical terminology and healthcare provider licensure requirements, with the ability to conduct primary source verifications.

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