Credentialing Specialist

At A.O. Fox, we are seeking a highly skilled Credentialing Specialist to join our team. In this role, you will be responsible for providing diversified, high-quality, and confidential credentialing services under the general supervision of the Manager of Medical Staff Affairs.

The Credentialing Specialist will work independently in cooperation with the MSA Manager, Physician Recruiters, Clinical Chiefs, and other personnel to lead, coordinate, monitor, and maintain the credentialing and re-credentialing process. This includes processing initial and reappointment applications within three days of receipt from the applicant with 95-100% accuracy as observed by the manager.

The ideal candidate will have a minimum of 1 year of administrative support or business office experience and be certified as a CPCS Certified Provider Credentialing Specialist. If you are a detail-oriented and organized individual with excellent communication skills, we encourage you to apply for this exciting opportunity.

Key Responsibilities:

• Process initial and reappointment applications within three days of receipt from the 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.
• 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.
• Respond to data requests and coordinate all new provider orientation schedules after approval by the Board of Trustees.
• Respond to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Respond weekly to affiliation/employment verification requests for all APCs and Medical Staff.
• Work collaboratively with the affiliate hospital Medical Staff Offices and attend meetings as assigned and prepare minutes as requested.
• Presents a positive image of A.O. Fox through professional appearance and behavior as observed by supervisor and feedback from customers.
• Attends all required hospital education programs.
• Accepts special projects and completes by the designated deadline.

Requirements:

• Minimum 1 year administrative support or business office experience.
• CPCS Certified Provider Credentialing Specialist, preferred.

Benefits:

• Paid time off, including company holidays, vacation, and sick time.
• Medical, dental, and vision insurance.
• Life insurance and disability protection.
• Retirement benefits, including an employer match.

Salary: Salary is based on a variety of factors, including qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards.

Equal Employment Opportunity: A.O. Fox provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.