Credentialing specialist

POSITION SUMMARY

This position performs the department's credentialing work as outlined in the policies and procedures. Obtains all primary source information necessary for all organizational facilities and entities.

The incumbent maintains records and the integrity of highly confidential information that is protected from discovery by applicable state statutes.

CORE FUNCTIONS

1. Performs the appropriate (applicable) credentialing processes in a timely and complete manner.

2. Performs analysis and appropriate follow-up. Works with many individuals to acquire necessary materials and information, including, but not limited to : physicians, facility staff, professional staff and physicians’ office staff.

3. Performs relevant data entry into the database to ensure consistency and integrity of the data.

4. Processes appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and maintains documentation in the database.

5. The incumbent performs and completes activities within the parameters established by the director and supervisor and as outlined in the facility / entity documents.

Manages own duties and functions independently. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive credentialing issues, decision making and discretion.

Uses independent decision making processes and handles assigned duties in a meaningful and confidential manner with a minimum of supervision.

Handles physician inquiries and problems within the scope of job function and keeps supervisors apprised of all issues as they occur.

Department and hospital responsibility. Internal customers include facility medical staff services, physicians, hospital personnel, corporate staff, hospital management, and volunteers.

External customers include but are not limited to regulatory / accrediting and licensing agencies, legal entities, state and national databases, other hospitals and the general public.

MINIMUM QUALIFICATIONS

Must possess a strong knowledge of business and / or healthcare as normally obtained through the completion of an associate’s degree.

Must possess a strong knowledge and understanding of healthcare planning as normally demonstrated through three years of credentialing and / or process management and operations experience.

Requires a basic knowledge of medical terminology, medical staff organization and extensive knowledge of credentialing procedures.

Must have experience in interacting with physicians and allied health professionals, their office credentialing representatives, and hospital personnel.

Must have excellent communication skills, both verbal and written, along with astute judgment in areas of human relations.

Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills.

Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.

Provides optimal customer service to meet the organization’s expectations.

PREFERRED QUALIFICATIONS

Additional related education and / or experience preferred.

EOE / Female / Minority / Disability / Veterans

Our organization supports a drug-free work environment.

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Last updated : 2024-03-04