Credentialing Specialist
Credentialing Specialist
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Job Description
Description
Purpose: Responsible for ensuring the timely and efficient credentialing including initial
appointment reappointment and privileging of all new and standing medical staff members
in order to be in compliance with regulatory bodies (Joint Commission NCQA URAC CMS
federal and state) as well as the Medical Staff Bylaws Rules and Regulations policies and
procedures and delegated contracts.
Essential Responsibilities:
1. Prepares disseminates collects reviews and processes applications for appointment
and reappointment and accompanying documents ensuring applicant eligibility.
2. Conducts thorough background investigation research and primary source
verification of all components of the application file including retrieval of National
Practitioner Database Reports in accordance with the Health Care Quality Act.
3. Identifies issues that require additional investigation and evaluation validates
discrepancies and ensures appropriate followup and closure.
4. Prepares and completes credential files for review by the appropriate department
chair and presentation at relevant Medical Staff Committees ensuring file completion
within time periods specified.
5. Reviews and processes request for change in privileges ensuring compliance with
the Medical Staff Bylaws Credentials Policy and criteria outlined in clinical privilege
descriptions.
6. Reviews and processes requests for change in staff status ensuring compliance with
the Medical Staff Bylaws and Credentials Policy
7. Responds to inquiries from other healthcare organizations interfaces with internal
and external customers on daytoday credentialing and privileging issue as they aris
and assists with credentialing audits by internal and external surveyors
8. Utilizes the credentialing database optimizing efficiency and performs data entry
query report and document generation.
9. Adheres to the credentialing and privileging process for assigned medical staff
members ensuring compliance with regulatory bodies (Joint Commission NCQA
URAC CMS federal and state) as well as the Medical Staff Bylaws Rules and
Regulations policies and procedures and delegated contracts.
10. Collects appointment and reappointment application fees annual medical staff dues
and reappointment fines
11. Creates updates and disseminates to relevant individuals within the organization
detailed reports on credentialing activities
12. Maintains and Models Nuvance Health Values.
13. Demonstrates regular reliable and predictable attendance.
14. Performs other duties as required.
Education and Experience Requirements:
Minimum three (3) years experience in credentialing or equivalent
experience preferred
Associates degree preferred
Minimum Knowledge Skills and Abilities Requirements:
Proficiency in the use of credentialing databases and MS Word Excel and
Outlook. Ability to: communicate effectively both orally and in writing; work
effectively in a team environment; plan prioritize and work multiple actives
and tasks effectively to produce work in high quantity and quality; to
analyze interpret and draw inferences from research findings and to prepare
reports; to use independent judgment to manage and impart confidential
information. Must have knowledge of related accreditation and certification
requirements to have knowledge of medical credentialing and privileging
procedures and standards working knowledge of clinical and /or hospital
operations and procedures database entry and management skills including
querying reporting and document generation.
License Registration or Certification Requirements:
Certified Provider Credentialing Specialist after 3 years on the job
experience
Working Conditions:
Manual: Little or no manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment: Generally pleasant working conditions
Company: Northern Dutchess Hospital
Org Unit: 1843
Department: Credentialing
Exempt: No
Salary Range: $20.86 $38.73 Hourly
Required Experience:
Unclear Seniority
Employment Type
Full Time
