Medical Staff Credentialing Specialist

1 week ago

Alexandria, Virginia, United States River Hospital Inc Full time
Medical Staff Credentialing Specialist

We are seeking a detail-oriented and highly organized Medical Staff Credentialing Specialist to become an integral part of our dynamic healthcare team at River Hospital Inc.

Job Responsibilities
  • Review and process credentialing and recredentialing applications for medical providers, ensuring accuracy and compliance with regulatory standards.
  • Verify medical staff credentials, including licenses, certifications, education, and training, to maintain up-to-date knowledge of regulatory requirements and accreditation standards.
  • Ensure compliance with federal and state laws, as well as hospital bylaws and policies regarding medical staff credentialing, and maintain accurate and complete credentialing files.
  • Conduct thorough background checks, including querying the National Practitioner Data Bank (NPDB), and collaborate with medical staff leadership and committees to review and assess credentialing files.
  • Manage the credentialing database to ensure information is accurate and current, and respond to verification requests and communicate credentialing status to relevant departments.
  • Prepare and maintain detailed reports regarding credentialing and recredentialing activities, and assist with the development and implementation of credentialing processes and procedures.
  • Coordinate with other departments to resolve any discrepancies or issues related to credentialing, and participate in audits and reviews to ensure the integrity of the credentialing process.
  • Facilitate ongoing provider credentialing education and training for staff and providers, and serve as a liaison between the medical staff and administration on credentialing matters.
  • Maintain strict confidentiality of provider information in accordance with HIPAA regulations.
Requirements
  • Associates degree in healthcare administration, human resources, business administration, or related field.
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
  • Minimum of 2 years of experience in medical staff services or credentialing in a healthcare setting.
  • Proficiency with credentialing databases and software.
  • Knowledge of national and state regulations, as well as accreditation standards related to credentialing.
  • Strong attention to detail and ability to maintain accurate and complete credentialing files.
  • Excellent organizational and time-management skills.
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, Teams).
  • Ability to handle sensitive information with discretion and maintain confidentiality.
  • Excellent written and verbal communication skills.
  • Ability to work independently and as part of a team.
  • Familiarity with medical terminology and healthcare provider licensure requirements.
  • Demonstrated ability to follow up on pending issues with persistence and determination.
  • Experience conducting primary source verifications.
  • Ability to multitask and meet strict deadlines.
  • Commitment to continuous professional development and keeping current with best practices in credentialing.
  • Customer service-oriented with the ability to interact.

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