Credentialing Specialist

Summary:

Under limited supervision, the Credentialing Verification Specialist (CVS) is responsible for maintaining credentialing and re-credentialing by thoroughly reviewing and verifying the credentials of licensed healthcare and behavioral health providers, such as doctors, dentists, physician assistants, nurse practitioners, social workers, CHA/Ps, and behavioral health therapists, to ensure they meet all necessary licensing, certification, and experience requirements to practice within a healthcare facility, by collecting primary source documentation, maintaining accurate records, and upholding compliance with relevant regulations and standards;

essentially acting as a gatekeeper to verify that licensed professionals are qualified to provide patient care.
Major Responsibilities:
• Process initial credentialing and re-credentialing applications for providers, carefully examining submitted documents like medical licenses, board certifications, malpractice insurance, and training certificates.

• Contact primary sources, such as medical schools, licensing boards, and hospitals, to verify the accuracy of information provided on applications.

• Maintain a comprehensive database of provider credentials, including expiration dates, ensuring information is updated and readily accessible.

• Stay abreast of changing regulations and standards related to healthcare credentialing, ensuring the facility adheres to all applicable laws.

• Perform quality checks on credentialing processes to identify potential errors or inconsistencies.

• Contact providers to request missing documentation, address concerns and provide updates on the credentialing process.

• The position serves as the head of the credentialing committee, which includes a representative from health services, community, and family services, as well as the Human Resources Director.

• Prepare reports and present findings to the credentialing committee for review and decision-making regarding provider privileges.

• Assist with internal and external credentialing audits, providing necessary documentation and addressing identified issues.

• Functions as primary contact for all internal and external inquiries for credentialing; develops and maintains positive working relationships.

• Release information to requesting agencies and public inquiries when required by law

• Performs other duties as assigned or required.

Education Requirements:

• Completing a bachelor's degree from an accredited university in a related field, such as healthcare administration, business administration, health information management, and medical terminology.

• The position requires five years of experience directly related to the duties and responsibilities specified.

• A combination of related work experience and education demonstrating the ability to fulfill the position's functions may qualify as a degree substitute.

• The National Association of Medical Staff Services (NAMSS) offers certification programs to recognize professional achievements in medical services management and provider credentialing, such as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS). Must have certification or actively pursuing certification within one year of hire.

Hours of Work:
The work hours are Monday to Friday, 8:30 a.m. to 5:00 p.m., with one hour for lunch. Chugachmiut maintains a drug/alcohol and non-smoking work environment. Travel to remote locations by boat, snowmobile, ATV, or small plane is needed, and employees must be willing and able to travel.