Credentialing Specialist

6 days ago

Ithaca, New York, United States Cayuga Health System Full time
Credentialing Specialist Job Description

Cayuga Health System is seeking a highly skilled Credentialing Specialist to join our team. The successful candidate will be responsible for coordinating and directing medical staff activities, ensuring that all services provided by medical facilities meet the required standards set by state and federal government agencies.

Key Responsibilities:

  • Assist with hiring new staff by reviewing resumes and applications to ensure that applicants fulfill all necessary licensing and credential requirements and eligibility for membership/participation.
  • Analyze application and supporting documents for completeness and inform the practitioner of the application status, including the need for any additional information.
  • Conduct primary source verification and verify that the professional training, certifications, and licensing of healthcare professionals are up to date and in compliance with state and federal regulations.
  • Perform background checks, contact licensing boards, review license applications, request education details, and interview references.
  • Conduct clinical competency evaluations and peer review, and maintain current clinical competency evaluations and peer review.
  • Organize information and data to identify trends, problems, and their causes, and compile, evaluate, and present practitioner-specific data for review by decision-making bodies.
  • Maintain databases for medical professionals and healthcare facilities, and perform initial, reappointment/re-credentialing for eligible practitioners, as well as processing of privilege and membership modification requests.
  • Manage compliance with accreditation standards and regulatory requirements, and facilitate medical staff functions, including orientation, training, and maintaining current provider credentialing files.

Requirements:

  • Associate's degree or H.S. Diploma with a minimum of 5 years directly related experience and CPSC Certification.
  • Previous work history and years of experience and certification may be considered in lieu of the above education requirement.
  • Residency in New York State and familiarity with NYS requirements are preferred.

Experience:

  • Five years of Medical Staff Office and Credentialing experience.
  • Strong oral and written communication skills.
  • Working knowledge of software applications, including Microsoft Word, Excel, and PowerPoint.
  • Ability to handle sensitive information with absolute confidentiality.
  • Organize work, effectively prioritize, and set short- or long-term goals and strategies to achieve them.
  • Align communication, people, processes, and resources to drive success.
  • Understand clinical competence evaluation concepts, key functions, and terminology.
  • Knowledge and understanding of Cayuga Health System medical staff, Medical Bylaws, Joint Commission Regulations, NYS Regulations, NCQA, and CMS Regulations.

Licensure:

  • CPCS certification is preferred.

Physical Requirements:

  • The ability to lift 25 pounds.

Compensation Disclosure:

  • $21.63 to $26.44.

Travel Requirements:

  • Remote.

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