Credentialing Specialist
Credentialing Specialist
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Job Description
Credentialing Specialist
Department: Medical Staff
Reports To: Systems Director and Department Supervisor
Job Summary:
Coordinates and directs medical staff activities in consultation with Vice President of Medical Affairs Medical Center President/CEO. Applies general understanding and specific procedures and policies through independent judgment. Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies. Supports departmental activities to ensure quality in conducting maintaining and communicating physician credentialing privileging and source verifications. Serves as a resource to and collaborates with others to advance the quality of practitioners and patient safety of the facility.
Job Responsibilities include:
- Assist with hiring new staff by reviewing resumes and applications to ensure that applicants fulfill all necessary licensing and credential requirements and eligibility for membership/participation.
- Analyzes application and supporting documents for completeness and informs the practitioner of the application status including the need for any additional information.
- Conducts participates in and maintains primary source verification.
- Verify that the professional training certifications and licensing of healthcare professionals which need to be renewed periodically are up to date and in compliance with state and federal regulations.
- Performs background checks contact licensing boards review license applications request education details and interview references.
- Conducts participates in and maintains current clinical competency evaluations and peer review.
- Organizes information and data to identify/explain trends problems and their causes.
- Compares contrasts and combines information to determine underlying issues. Sees associations between seemingly independent problems or events to recognize trends problems and possible cause-effect relationships.
- Compiles evaluates and presents the practitioner-specific data collected for review by one or more decision-making bodies.
- Maintains databases for medical professionals and healthcare facilities
- Performs initial reappointment/re-credentialing for eligible practitioners as well as processing of privilege and membership modification requests.
- Manages compliance with accreditation standards and regulatory requirements.
- Complies with accreditation and regulatory standards.
- Facilitate medical staff functions (Orientation Training maintaining current provider credentialing files).
- Is flexible in assuming other appropriate responsibilities not noted above.
Requirements:
Education - Associates degree or H.S. Diploma with minimum of 5 years directly related experience and CPSC Certification.
In lieu of the above education requirement previous work history and years of experience and certification may/will be considered.
Residency in New York State and familiarity with NYS requirements preferred.
Experience -
- Five years of Medical Staff Office and Credentialing experience.
- Strong oral and written communication skills.
- Working knowledge of software applications including Microsoft Word Excel and PowerPoint.
- Ability to handle sensitive information with absolute confidentiality.
- Organizes work effectively prioritizes and sets short- or long-term goals and strategies to achieve them.
- Aligns communication people processes and resources to drive success.
- Understands clinical competence evaluation concepts key functions and terminology
- Knowledge and understanding of Cayuga Health System medical staff Medical Bylaws Joint Commission Regulations NYS Regulations NCQA and CMS Regulations.
Licensure - CPCS certification preferred
Physical Requirements - The ability to lift 25 pounds.
Compensation Disclosure
- $21.63 to $26.44
Location Requirements:
- Onsite
At this time Cayuga Health System will not sponsor a new applicant for employment authorization for this position.
If you are interested in applying for this position and you require an accommodation please contact Cayuga Health System at
Cayuga Health System Commitment to Diversity Equity & Inclusion
Cayuga Health System commits to treating all people with dignity so that everyone who comes to us is safe cared for and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities needs and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access equitable care and good health outcomes.
Cayuga Health is dedicated to our vision for diversity equity and inclusion. As we strive towards our vision we welcome the opportunity to work alongside a diverse range of employees.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
