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Credentialing Specialist

1 month ago

Oneonta NY USA, United States Bassett Healthcare Full time

Job Summary

Bassett Healthcare Network is seeking a skilled Credentialing Specialist to join our team. As a Credentialing Specialist, you will play a critical role in ensuring the accuracy and integrity of our credentialing database system and related applications.

Key Responsibilities

  • Process initial and reappointment applications within three days of receipt from applicant with 95-100% accuracy as observed by the manager.
  • Accurately enter practitioner information into the credentialing database within three days of receipt with 95-100% accuracy as observed by the manager.
  • Perform primary source verification on all practitioners, which includes sending letters to verify licensure, board certification, education, internship, residency, fellowship, references, NPDB, Medicare/Medicaid sanctions, etc.
  • Identify red flags, and items requiring further review/additional information and bring them forth to the MSA Manager, Clinical Chief and the Medical Staff President.
  • Ensure compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.
  • Process requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
  • Maintain confidentiality of all credentialing information as noted in the Medical Staff Policy and Procedure Manual and as observed by the manager.
  • Assemble all credentialing packets for presentation to the Credentials Committee of the Medical Staff.
  • Serve as a resource to practitioners and clinical chiefs with issues regarding licensing, board certifications, and anything else that would encompass credentialing.
  • Communicate regularly with the practitioner and Clinical Chief regarding the credentialing status Conduct regular internal audits of the credentialing files to ensure compliance with regulatory agencies, Medical Staff Policies and Procedures and Bylaws.
  • Responsible for the accuracy and integrity of the credentialing database system and related applications.
  • Maintain an accurate and up-to-date record of internal and external CME's in the providers file.
  • Responds to data requests.

Requirements

  • High School Diploma or equivalent, required 2 Year / Associate degree, preferred
  • Minimum 1 year administrative support or business office experience, required
  • Minimum 1 year experience with extensive public contact and customer service, required
  • CPCS – Certified Provider Credentialing Specialist, preferred

Work Environment

Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

Sedentary work involves sitting most of the time.

Occasional lifting, pulling, pushing, reaching, standing, stooping, walking Constant typing/clerical/dexterity, grasping, hearing, repetitive motion, seeing/monitor/computer use, talking, visual acuity

Occasional Travel - The job may require travel from time- to-time, but not on a regular basis