Credentialing Specialist

Delta Health offers health care professionals and people from all walks of life an opportunity to find fulfillment in their jobs as part of a close-knit team. We pride ourselves on our positive work culture. Our team members understand our fundamental commitment to the community and rally around the motto “Excellence, Every Patient, Every Time.” When you embark on a journey with us, you’ll take pride in your work and the impact you have, while building a career with focus and purpose.

Credentialing Specialists evaluates, analyzes and coordinates all aspects of the credentialing and re-credentialing processes for practitioners practicing with the Delta Health System clinical entities. Provides integral support to healthcare operations by enabling timely onboarding and completion of the credentialing process for providers.

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and Delta Health regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Delta Health criteria.
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to the Sr. Revenue Cycle Director and Chief Legal Officer for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
• Communicates clearly with providers, their liaisons, Medical Staff Coordinator, and Sr. Revenue Cycle Director, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Performs miscellaneous job-related duties as assigned.

• High school diploma or GED; at least 5 years of experience directly related to the duties and responsibilities specified.
• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
• AAPC Credentialing Specialist Certification preferred.

Knowledge, Skills and Abilities Required:

• Ability to communicate effectively both orally and in writing.
• Customer service skills.
• Ability to respond to emails timely and effectively.
• Information research skills.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Working knowledge of clinical and/or hospital operations and procedures.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
• Ability to make administrative/procedural decisions and judgments.
• Demonstrated advanced working knowledge of Microsoft Word and Excel.
• Ability to learn new applications to function effectively in a remote work environment.
• Skill in establishing priorities with independent coordination of day-to-day aspects.
• Advanced skills in computerized spread sheets and database management.
• No or very limited physical effort required.
• No or very limited exposure to physical risk.
• Work is normally performed remote work environment.

Why Delta County

Delta Health is a county-wide healthcare system that has been serving the Western Slope for over 100 years. We have grown to a 49-bed hospital with locations throughout Delta County. We proudly provide a wide range of medical services that meet the diverse needs of our community members. At all stages of life, we are here to provide remarkable care in a healing environment.

Benefits Summary

Employee Benefits: Medical, RX, Dental, Vision, Retirement, PTO, and Scholarships towards continued education.

Medical: Low monthly premiums; 100% coverage for all services provided within our Delta Health System without a deductible or co-payment. We offer alternative coverage to include massage, acupuncture, and chiropractic care. Employer paid Life and Disability coverage.

Paid Time Off: 4 plus weeks of vacation (CAL) a year for Full-Time employees including sick pay and personal time off.

Retirement: 403B Plan -Up to a 3% retirement match.