Credentialing Specialist

Job Description

REQUIREMENTS

• Two (2) years of college (specifically business courses) or
• One (1) to three (3) years of experience in a medical staff office or credentials position
• Excellent organization skills with the ability to handle multi-tasks
• Excellent interpersonal skills
• Excellent negotiation and persuasion skills

RESPONSIBILITES

• Carries out the process as outlined in our client’s Coordination of Credentials Policies and Procedure Manual
• Establish working relationships with internal and external personnel to facilitate all aspects of facility application processes as it relates to receiving privileges or approvals to work at a facility (ies) and maintaining the privileges.
• Collaborate with clinicians and/or other internal/external resources if/when a new state license is needed for clinician(s)
• Coordination, receipt, and data entry of clinician information via standardized processes in the credentials software system(s) for the purpose of ensuring clinician information is accurate and up-to-date
• Ensures current documentation is on file for all contracted clinicians and all pertinent documentation is forwarded to appropriate privileging and non-privileging facilities for initial privileges / approvals and reappointments.
• Facilitates and tracks the entire facility application and reappointment process and documents accordingly.
• Initiates and ensures malpractice coverage for clinicians
• Ensures facility requirements are met in order to present applications to facilities’ Medical Staff Offices or Post-Acute places of service in accordance with quality standards
• Prepares and ensures accuracy of clinician applications for hospital privileges / approvals.
• Performs follow-up per guidelines with hospitals and post-acute facilities. Notify stakeholders: Onboarding ,Provider Enrollment, VPOs, FMD’s, RMD, scheduler, and recruiters about the credentialing status
• Maintains Credentials database(s) to identify and disseminate to others (onboarding, provider enrollment, recruiting, scheduling, contracting) hospital privilege / approval report status
• Coordinates, completes, and follows-up on the reappointment process for hospitals.
• Ensures appropriate APC and Supervisory paperwork is complete, based on clinician type and the requirements of our client, State(s) and Facility(ies)
• Ensures appropriate state ratio(s) are maintained for APC and Supervisory relationships
• Maintains personal adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical, and facility policies
• Interfacing with clinicians, Onboarding and other departments as needed

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