Credentialing Specialist

2 weeks ago

Livonia, Michigan, United States Trinity Health Full time


Employment Type:

Full time
Shift:

Day Shift


Position Overview:


The Credentialing Specialist plays a crucial role in ensuring the prompt and efficient processing of applications for initial and re-credentialing by guiding applicants in submitting all necessary documentation.

This role involves executing various credentialing tasks under the supervision of management to finalize the credentialing procedures for Trinity Health's Regional Health Managers (RHMs).

As a vital member of the credentialing team, this position adheres to established credentialing policies and procedures, maintains an accurate database of physicians, collects essential data, and contributes to the enhancement and implementation of credentialing processes.

KEY RESPONSIBILITIES

Embraces and exemplifies the Mission, Vision, and Values of Trinity Health in all actions and decisions.

Assists management in identifying and scheduling candidates for reappointment.

Conducts file audits and provides constructive feedback on completed credentialing files for initial and reappointment processes.

Supports the training and onboarding of new team members.

Engages in daily data entry to maintain an accurate physician database.


Facilitates the integration of new RHMs into the Credentialing Verification Organization (CVO) by assisting with data entry and/or data conversion into the physician database.

Maintains regular communication with applicants and RHMs to fulfill all credentialing requirements within established timelines.


Contacts various primary sources to obtain necessary verifications for background investigations through multiple communication methods, ensuring timely application completion.

Documents all verifications, including a summary of verified references for each completed credentialing file.

Assists in the reappointment process by gathering required information, verifying details, and conducting necessary follow-ups to finalize reappointment applications.

Consistently meets processing time benchmarks with minimal errors.

Assists in drafting RHM privilege forms within the credentialing database.

Upholds the confidentiality of sensitive information related to patients, physicians, employees, and external entities.

Maintains a customer-focused approach, fostering positive relationships and addressing conflicts constructively. Identifies issues, proposes solutions, and participates in their resolution.


Tracks errors and complaints to support continuous process improvement initiatives.

Engages in professional development and participates in relevant organizations to enhance understanding of healthcare regulations and legislation.

Maintains confidentiality regarding patient and hospital information, discussing such matters only with appropriate personnel in private settings.


Takes responsibility for performing job duties safely, ensuring personal and coworker safety, and promptly reporting any hazards or unsafe practices to management.

Performs additional duties as assigned by the Director.


Maintains familiarity with applicable federal, state, and local laws/regulations, as well as Trinity Health's Integrity and Compliance Program and Code of Conduct, to ensure adherence to ethical and professional standards.

MINIMUM QUALIFICATIONS

Requires two years of post-secondary education, training, or experience. An associate degree in health administration or a related field is preferred.


One year of experience in a healthcare setting with a general understanding of the healthcare industry, including hospitals, physician practices, and managed care organizations.

Knowledge of NCQA and TJC standards, NPDB guidelines, hospital policies, and general licensing regulations is essential.

Experience with database management, report generation, and proficiency in Windows-based word processing software is required.

Current CPCS and/or CPMSM eligibility from the National Association Medical Staff Services is preferred but not mandatory.


Strong communication skills are necessary, including the ability to effectively correspond and convey information clearly, actively listen, and consider diverse perspectives in decision-making.

Demonstrated statistical, analytical, and problem-solving abilities are essential. A commitment to providing quality service to others, along with strong organizational skills and attention to detail, is required. Ability to work independently and collaboratively within a team environment is crucial. Compliance with Trinity Health policies and procedures is mandatory.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be capable of organizing and prioritizing work effectively, adapting to frequently changing priorities.

Ability to manage multiple tasks/projects concurrently in a potentially stressful environment with diverse personalities and work styles is essential.


Ability to maintain composure and a positive attitude during high-pressure situations is required.

Hourly Pay Range: $31.65


The above statements are intended to outline the general nature and level of work performed by individuals in this classification.

They are not intended to be an exhaustive list of all duties assigned.

Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation.

Grounded in our Mission and Core Values, we prioritize diversity, equity, and inclusion in all our endeavors.

Our workforce is enriched by varied experiences, customs, abilities, and talents. Together, we strive to be our best selves. A diverse and inclusive workforce enables us to provide the most accessible and equitable care to those we serve. Trinity Health is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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