Healthcare Credentialing Specialist

4 weeks ago

Detroit, Michigan, United States PSG Global Solutions Careers Full time

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The Opportunity

Description

We're looking for a Credentialing Specialist, working in the Healthcare Systems and Services industry in the United States.

We're hiring Credentialing Specialists in the US, offering opportunities to work with healthcare professionals and organizations. In this role, you'll focus on managing the credentialing and re-credentialing process, ensuring compliance with industry standards and regulations.

Your Responsibilities as a Credentialing Specialist:

  • Responsible for verifications for medical staff and allied health professionals' initial appointments, provisional reviews, reappointments, and privilege delineation.
  • Coordinates the processing of applications. Assures all applications are processed completely and promptly.
  • Verifies required primary source credentialing documentation to ensure medical staff and allied health professional files are current and policies and procedures have been followed to obtain required documentation and verification.
  • Coordinates activities and explains procedures to facilitate the reappointment process.
  • Requests confidential information such as case logs, procedures, and other sensitive matters.
  • Tracks responses and follows up on items not received within established time frames.
  • Maintains credentialing software database by ensuring that data entered is complete and accurate.
  • Submits completed files to MSO offices and delegated entities.
  • Acts as a liaison between company and the CCS.
  • Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information.
  • Assists in compliance with the accrediting and regulatory agencies (i.e. The Joint Commission, NCQA, URAC, HFAP) regarding credentialing while developing and maintaining a working knowledge of the statutes and laws.
  • Improves professional growth, and knowledge of the job to maintain efficiency and effectiveness of the CCS by participating in professional organizations, attending seminars, and reading journals and publications addressing medical staff services activities and trends.
  • Participates in system integration and continuing quality improvement efforts.
  • Receives, evaluates, and answers customer inquiries and provides customer support by corporate standards of excellence.
  • Performs other duties as required which are subject to change at the discretion of management.

Our Client

As a woman-owned company, our client brings over 40 years of expertise in staffing and recruiting to connect top nursing, allied health, and non-clinical professionals with leading healthcare facilities across the Southwestern U.S. and beyond.

Their mission is simple: provide exceptional service to both their candidates and healthcare facilities by truly understanding their unique needs.

Our client believes that securing the best candidates means delivering the best results for the healthcare facilities they support -every time.

Experience Required for Your Success Requirements:

  • 2+ Years of Prime Source Credentialing Experience
  • MUST have 1+ years of Hospital Credentialing Experience (outpatient/clinic experience does not apply)
  • MUST be proficient with using MDStaff Credentialing Software
  • End-to-end provider Credentialing Experience (MDs & DOs)
  • Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and all applicable standards.
  • Must be able to work independently in a fast-paced environment
  • Can be onsite or remote (must live near Detroit - will be required to pick up equipment and briefly orient onsite)
  • All RTO Requests, scheduling conflicts, etc. must be provided at the time of submittal
  • Must have access to a router near a plug to set up the computer and ethernet
  • Candidate must have excellent organization skills and be able to hit the ground running with minimal training. The expectation is to have 2-6 files completed daily. The candidate will start the assignment with 40 files to manage

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