Credentialing Specialist Detroit

General Summary

Under general supervision, responsible for all functions relating to the credentialing and recredentialing of practitioner applicants. Responsibilities include data entry, data collection, and verification of credentials from primary source and analysis of information collected for presentation to medical staff leadership.

• Responsible for verifications for medical staff and allied health professionals initial appointments, provisional reviews, reappointments and privilege delineation; coordinates the processing of applications and assures all applications are processed completely and in a timely manner.
• Verifies required primary source credentialing documentation to ensure files are current and policies and procedures have been followed to obtain required documentation and verification.
• Coordinates activities and explains procedure to facilitate the reappointment process.
• Requests confidential information such as case logs, procedures and other sensitive matters.
• Tracks responses and follows up on items not received within established time frames.
• Maintains credentialing software database by ensuring that data entered is complete and accurate.
• Submits completed files to MSO offices and delegated entities.
• Acts as a liaison between Henry Ford Health System facilities and the CCS.
• Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information.
• Assists in compliance with accrediting and regulatory agencies (i.e. The Joint Commission, NCQA, URAC, HFAP) in regard to credentialing while developing and maintaining a working knowledge of statutes and laws.
• Improves professional growth and knowledge of the job to maintain efficiency and effectiveness of the CCS by participating in professional organizations, attending seminars and reading journals and publications addressing medical staff services activities and trends.
• Participates in system integration and continuing quality improvement efforts.
• Receives, evaluates and answers customer inquiries and provides customer support in accordance with corporate standards of excellence.
• Performs other duties as required which are subject to change at the discretion of management.

• High School Diploma required. Associate’s Degree, preferred.
• 1 year of credentialing, provider enrollment, or background/verification specialist experience required.
• High level of energy to work in a fast‑paced environment often including time deadlines, frequent interruptions, multiple demands and multi‑tasking.
• Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and all applicable standards.

• Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
• Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy.
• Must practice the customer skills as provided through ongoing training and in‑services.

• Organization:
  Corporate Services
• Department:
  Central Verification Office
• Shift: Day Job
• Union Code:
  Not Applicable