Medical Staff Credentialing Specialist, Sr. processes credentialing and recredentialing applications for health care providers. Mails, reviews, and verifies credentialing applications. Being a Medical Staff Credentialing Specialist, Sr. loads and maintains provider information in an online credentialing database system. Tracks license and certification expirations for medical staff to ensure timely renewals. Additionally, Medical Staff Credentialing Specialist, Sr. handles and resolves inquiries regarding credentialing information, process, or status. May provide guidance or expertise to less experienced specialists. Requires a high school diploma. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor. The Medical Staff Credentialing Specialist, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Medical Staff Credentialing Specialist, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Under the supervision of the Manager, the Credentialing Specialist is responsible for the execution of all activities related to the appointment or re-appointment of Members and Affiliated Members of the Medical Staff. This includes thorough evaluation of the application upon receipt against the Medical Staff Bylaws to determine eligibility and troubleshooting all steps throughout the processing of each application to ensure completeness and compliance with Medical Staff Bylaws, Department Policies and Procedures, Joint Commission (JC), State of Connecticut Department of Public Health (DPH), Centers for Medicare and Medicaid Services (CMS) and National Committee on Quality Assurance (NCQA) regulations. The Credentialing Specialist is also responsible for the completeness and accuracy of all data entry including demographic and clinical privilege information which is used both in the Department of Physician Services and hospital-wide.
EEO/AA/Disability/Veteran
EDUCATION
Bachelor of Arts or Bachelor of Science Degree with a concentration in liberal arts or science strongly preferred. Experience in a hospital, medical group practice, or other similar health care environment and familiarity with physician specialties required. Previous experience in credentialing preferred.
EXPERIENCE
Two to three years experience in the healthcare industry supporting an understanding of physicians and physician specialties required., CPMSM or CPCS desirable but not required.
SPECIAL SKILLS
Ability to work with a high level of accuracy involving extreme levels of detail. Must have a high level of customer service skills and professionalism. Must be able to perform responsibilities with minimal direct supervision. Must have exemplary organizational, communication and customer service skills. Must have strong writing skills and be able to compose written/electronic appropriate communication independently. Must have a general understanding of medical terminology. Must be able to work under pressure and towards strict deadlines while concurrently keeping track of multiple processes in multiple stages of completion. Strong computer skills particularly in Microsoft word. Experience with credentialing software system desirable. Must be able to use appropriate discretion and maintain strict confidentiality with respect to all physician information as applicable.
PHYSICAL DEMAND
Works in a office setting. Must be able to sit at a desk for extended periods of time and work at a computer. Must be able to walk as position routinely requires the delivery and pick up of documents throughout the Medical Center. Must be able to file.
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