Credentialing Specialist

QUALIFICATIONS    

EDUCATION/CERTIFICATION: Associates Degree

REQUIRED KNOWLEDGE:      Great understanding of healthcare terminology processes and strategies.

EXPERIENCE REQUIRED:       3 or more years of experience in credentialing in the healthcare field

ESSENTIAL FUNCTIONS AND BASIC DUTIES

Credentialing:

• Organizing and reviewing credentialing and re-credentialing Medical and Allied Health Professional Staffs applications for completeness and accuracy.


• Responsible for the credentialing process for Military Treatment Facilities, VA Hospitals, I.H S Facilities, or other contracted healthcare facilities.


• Performing primary source verifications of education, training, experience, certifications and boards, “as they relate to compliance with the Medical Staff Bylaws, Rules and Regulations, and all federal, state and local accrediting agencies."


• Collects, reviews and investigates pertinent documentation. Reports any and all red flag issues.


• Requests national criminal history background checks on all providers and medical support staff.


• Organizes and submits “credentialing" documentation for review and approval.
  
  Maintains data in computer database and electronic copy file systems with effective dates related to licensing, certifications, renewals, vaccinations and all other instances in compliance with company and client policies.


• Attend meetings associated with medical staff credentialing


• Interacts with Medical Staff members, leadership, co-workers, visitors as well as other institutions and practices.


• Performs regular reviews and reporting of Quality Indicators on Medical Staff


• Regular use of standard office equipment.


• Coordinates and maintains all new hire and ongoing credentialing projects


• Act as liaison with clients to ensure candidates are credentialed based on their facilities requirements and are delivered in a timely manner


• Prepare all documentation required for credentialing presentation

Team Lead Duties

• Master entire process, work flow, requirements and expectations for assigned program.


• Act as a ‘go-to’ for any questions, process or policy updates and program specific initiatives


• Communicate and work closely with the PMs & DPMs per program to discuss files, accountability, changes or areas for growth for the team.


• Communicates issues and concerns with appropriate PM


• Works with team members to ensure their files and workload are covered during absences up to and including temporary reassignment to other team members


• Assists CSM in Quality Checking files prior to delivery


• Assists CSM in interviewing and training new hires for their team


• Answers team questions about program specific issues and processes and escalates to CSM as needed


• Insures credentialing notes for their team are current on Google Doc and brings any deficiencies to the attention of the credentialing specialist
  
  
  
  • Reports any ongoing/repeated deficiencies to the CSM
  
  
  
  


• Identifies files that are taking longer than expected to complete and works with the credentialing specialist to resolve the delay
  
  
  
  • Reports any ongoing/repeated delays to the CSM
  
  
  
  


• Meets with CSM for weekly one-on-one’s


• Is in touch with the needs of the team and works to promote good morale


• Works to identify credentialing/personnel issues and concerns
  
  
  
  • Reports all credentialing/personnel issues and concerns to the CSM
  
  
  • Assists with resolution when appropriate
  
  
  
  


• When CSM is out of the office:
  
  
  
  • Covers call-outs and PTO requests
  
  
  • Reports to CSM’s supervisor (Leigh Pace)
  
  
  • Coordinates file assignments and updates Credentialing Tracking Log