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Healthcare Credentialing Specialist

2 months ago

Atlanta, Georgia, United States Morehouse School of Medicine Full time
Position Overview:
The Faculty Credentialing Coordinator plays a pivotal role in the onboarding, credentialing, and re-credentialing processes for healthcare professionals. This position is essential in ensuring that all faculty members are properly credentialed. The Coordinator operates independently while frequently collaborating with colleagues within the Clinical Enterprise's Credentialing Departments. The role involves onboarding new faculty members into the Department of Medicine and providing high-level administrative support of a confidential and professional nature to ensure the efficient functioning of daily departmental operations.

Minimum Qualifications:

Education:
Associates degree is required.

Experience:
  • A minimum of two (2) years of experience as a credentialing coordinator or specialist focused on provider enrollment.
  • At least two (2) years of experience in onboarding healthcare providers.

Preferred Qualifications:
  • Bachelor's degree in a healthcare-related field, business administration, or a similar discipline is preferred.
  • Candidates with a healthcare background and experience with EPIC are strongly preferred.
  • Certification as a Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) is preferred.
  • Familiarity with the CAQH (Council for Affordable Quality Healthcare) database and application process.
  • Knowledge of credentialing accreditation regulations and policies.
  • Self-motivated individuals with excellent communication skills and strong attention to detail are highly valued.
  • Critical thinking, problem-solving abilities, and relationship-building skills are essential.
  • Proficient written communication skills for reports, letters, memos, and emails.
  • Proficiency in Microsoft Office applications: Word, Excel, PowerPoint, and Visio.
  • Strong customer service, organizational, problem-solving, and time management skills are crucial.

Key Responsibilities:

Credentialing Operations:
  • Obtain and verify necessary credentialing documents during provider onboarding.
  • Ensure compliance with relevant accrediting and regulatory agencies regarding credentialing functions, including application management and primary source verification.
  • Maintain accurate and current data for all providers.
  • Complete credentialing and re-credentialing applications for providers.
  • Monitor applications and follow up as necessary.
  • Keep copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
  • Stay informed about hospital-specific credentialing requirements.
  • Set up and maintain provider information in online credentialing databases.
  • Track expiration dates for licenses and certifications to ensure timely renewals.
  • Coordinate with hospitals and physicians to finalize the credentialing process, including any additional documentation and verifications required.
  • Review applications for accuracy before submission.
  • Conduct onboarding document requests and primary verification sources.
  • Manage the process of expirable documents to ensure all provider licenses and certificates remain current.
  • Address discrepancies as needed from payors.
  • Process re-credentialing requests for providers.
  • Respond to inquiries and process requests related to credentialing information.
  • Collect primary source verification documentation as required based on NCQA standards and health plan requirements.
  • Maintain the credentialing database with up-to-date information.
  • Monitor credentialing requirements and ensure timely collection of all renewal certifications.
  • Provide consistent follow-up on outstanding credentialing files.
  • Prepare and scan credentialing documentation into appropriate software.
  • Process changes in provider demographics and notify health plans accordingly.
  • Handle provider network terminations and leave of absence requests.
  • Perform additional duties as assigned.

Onboarding Operations:
  • Act as the Faculty Coordinator for the Chair and Director of Finance and Business Operations within a complex clinical department.
  • Serve as the primary administrative contact for faculty recruitment and onboarding, as well as credentialing matters.
  • Develop strong professional relationships with various departments, faculty, hospital liaisons, and other stakeholders.
  • Coordinate faculty appointments, initial credentialing, re-credentialing, annual evaluations, and promotion packages.
  • Manage functions related to adjunct faculty, including appointments and maintaining a database of contributions.
  • Oversee Department Grand Round activities and other CME events, ensuring adherence to accreditation standards.

Pre-Employment Requirements:
All employment offers are contingent upon successful completion of pre-employment screenings, including immunization requirements for COVID-19 and Seasonal Influenza as applicable.