Credentialing Specialist

SUMMARY:

Reporting jointly to the Credentials Coordinators and the Credentials Manager, this position provides facilitation of the requirements of the regulatory and accreditation standards that govern the credentialing and privileging of the medical and allied health staff of all Brown University Health System facilities which include community hospitals, clinics and outpatient services as well as BHMG group practices. The position requires a background with working knowledge of the federal and state regulations, various accreditation standards and licensing requirements for the professional staff as they govern the credentialing, privileging and peer review process.

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

Processing of departmental credentialing requests, in accordance with established procedures and time frames.
Preparation of initial and reappointment application packets for assigned area of responsibility.
Tracking of initial and reapplications sent, received, and processing time.
Takes action on non-returned new and (re) applications and conducts follow-up of initial and (re) applications in accordance with policies and procedures.
Reviews initial (re) applications for clarity, quality, and completeness of data in accordance with policies and procedures.
Performs timely and accurate scanning, data entry/entry validation of application information received in the database.
Initiation of the verification process within established time frames.
Responds to verification requests as received, compares the responses with the information provided by applicant to ensure accuracy and completeness.
Provides timely resolution of any verification problems/ discrepancies in order to ensure timely completion of the verification process.
Conducts follow-up on missing data and/or discrepancies and other potential problems, reporting to MSSD coordinators and leadership as well as entity contact when appropriate in accordance with established time frames, working to ensure the completion of the verification process within established time frames to allow time to complete the committee reviews prior to anticipated appointment/next reappointment date.
Keeps applicants (initial and reappointment) informed of the status of credentialing process which includes timely use of all correspondence as well as proper notification to the applicant.
Serves as a liaison with other internal/external customers as it relates to practitioner related issues and concerns.
Data Management Responsibilities
Maintains an electronic record/file for all practitioners within the credentialing database giving attention to operational concerns and the need for others to retrieve the same records.
Maintains integrity of electronic, specialized database, which includes the entering and importing of practitioner information in accordance with departmental policies and procedures.
Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation.
Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database.
Assists with the development and revision of the credentialing and audit workflows within the credentialing database.
Maintains competency on vendor…