Lead Credentialing Specialist

1 week ago

New York, New York, United States SUNY Downstate Health Sciences University Full time
Job Summary: The Medical Board Office at SUNY Downstate Health Sciences University is seeking a full-time TH Staff Assistant 1 / Lead Credentialing Specialist. The successful candidate will be responsible for processing applications for initial appointments and reappointments, collecting and analyzing primary source verifications of credentials, and assembling and preparing credentialing files for review. Additionally, the candidate will perform accurate data entry to credentialing software, track and update expired credentials, and maintain a working knowledge of credentialing requirements and standards. The ideal candidate will have a Bachelor's Degree and 2 years of medical credentialing experience, with excellent oral and written communication skills and the ability to handle a large work volume independently in a high-paced environment.

Key Responsibilities:
  • Process applications for initial appointments and reappointments within 60 days, in compliance with Bylaws, P&P, NCQA, CME, Joint Commission Standards, and other state and federal regulations.
  • Collect and analyze primary source verifications of credentials, education, and training for potential compliance issues and generate follow-up requests for additional information if necessary.
  • Assemble and prepare credentialing files for review by the Director, Clinical Department Chairs/Chiefs, and Creds Committee and Medical Executive Committee.
  • Perform accurate data entry to credentialing software and assist with database management.
  • Track, monitor, and update expired credentials and information to ensure accurate and current data exist for each practitioner maintained in the database and those provider's licenses and certifications remain current.
  • Maintain and apply working knowledge of the credentialing requirements and standards of CMS and NY State law relating to credentialing, privileging, and the medical staff organization, the Joint Commission, and NCQA.
  • Coordinate and support meetings of the Credentials Committee, Medical Executive Committee, or the Medical Staff and coordinate follow-up from meetings to assure that action is taken, referrals are timely, and notifications to individuals as necessary are completed.
  • Assist with reviewing and preparing credential files to ensure compliance for Managed Care audits, site visits, and accreditation surveys.
  • Process requests for verifications of hospital affiliations (2805s) to respond within 45 days of the date of requests.
  • Support the Medical Board administrative functions (answering phones, reception, filing, scanning, audit preparations, mailings).
  • Perform quality review of initials and reappointments and provide feedback on findings to the credentialing staff.
  • Participate in training and orienting new staff to the Medical Staff Office.
  • Support Director of Medical Staff Offices and provides leadership coverage when director is out.
  • Perform other duties as assigned and assist in special projects as needed to meet department and/or system needs.
Requirements:
  • Bachelor's Degree and 2 years of medical credentialing experience.
  • Ability to handle large work volume independently in a high-paced environment.
  • Excellent oral and written communication skills, excellent customer service skills, and detail-oriented.
Preferred Qualifications:
  • Certified Provider Credentialing Specialist or Certified Professional Medical Services Management.
Work Schedule: Monday to Friday; 8:30am to 4:30pm (Full-Time)Salary Grade/Rank: SL-2Salary Range: Commensurate with experience and qualificationsEqual Employment Opportunity Statement: SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws. Women, minorities, veterans, individuals with disabilities, and members of underrepresented groups are encouraged to apply.

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