Credentialing Specialist jobs in Farmington, NM

Overview

Supports the Medical and Allied Health Staff credentialing/primary sourcing verification program by coordinating and developing internal processes in order to meet requirements of federal and state regulatory and national accreditation agencies. Monitors timeliness of processes and provides feedback and/or reports to the appropriate manager. Audits accuracy of data entry in the credentialing database and provides feedback to appropriate internal and external customers. This position requires in-depth knowledge of medical and allied health staff credentialing processes and requirements. Investigates issues of concern and conducts follow-up as needed, generates reports and presents findings to the Manager of Medical Staff Affairs (MSA) or Manager of Credentials Verification Organization (CVO). Serves as a subject matter expert to other PHS departments and facilities as it relates to the processing of initial and/or reappointment applications and/or privileging. Responsible for assigned duties and responsibilities to ensure compliance with the Medical Staff Bylaws, Rules/Regulations and/ or the daily work flow of the CVO. Works with the appropriate manager in the development of policies and procedures to meet regulatory and accreditation requirements. Manages special projects as assigned

Type of Opportunity: Full Time FTE: 1.000000 Exempt: Yes Work Schedule: Days

Qualifications

Associate s Degree/Diploma in medical staff services studies, or a related field preferred. Three to five years experience in medical staff affairs/credentialing, credentials verification organization, or related field preferred. Public relation skills required in order to be effective and behave in a professional manner when dealing with practitioners and customers. Requires excellent time management and organizational skills in order to handle multiple projects simultaneously. Certification or eligibility for certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred. 

Education:Essential:* High School Diploma or GED

Responsibilities

Responsibilities:*Assists the Medical Director Department leadership in managing activities to ensure a coordinated effort to fulfill departmental responsibilities within its long-range plans and goals*Exercises discretion and independent judgment involving the comparison and the evaluation of possible courses of action related to meeting primary source verification and credentialing requirements. Acts or reaches decisions independently after the various possibilities have been considered. * Investigates discrepancies in data submittal related to applications and privileging and formulates appropriate course of action.*Provides excellent customer service by responding to provider, client, and customer inquiries within specified timeframes, as required by the department*Maintains statistical information relative to the department s quality indicators*Responsible for orientation/training of new and current employees as it relates to departmental procedures, credentialing database, and daily work*Serves as a subject matter expert on appropriate national accreditation agencies and federal/state regulations pertaining to required credentialing processes*Maintains knowledge base of appropriate national accrediting agencies

Benefits

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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