Credentials Specialist

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation.

NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

For more information, go to NYU Langone Health, and interact with us on Linked In, Glassdoor, Indeed, Facebook, Twitter, You Tube and Instagram.

We have an exciting opportunity to join our team as a Credentials Specialist. In this role, the successful candidate is responsible for initiating, processing, reviewing and analyzing physician/allied health applications for initial appointment in accordance with established credentialing standards.

• Performs other duties and assists with special projects as assigned.
• Initiates, processes, reviews and analyzes physician/allied health applications for initial appointment exercising discretion and independent judgment with respect to applicable credentialing standards.
• Conducts/reviews primary source verification and validation of credentialing documents including clinical education/training, board certification and eligibility, licensure, accreditation, work history, liability insurance and malpractice claims history. Assesses completeness of information and qualifications relative to credentialing standards.
• Independently identifies and flags adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for Credentials Committee review. Uses discretion to elevate identified flags to management.
• Enters data from provider applications into Cactus database, including provider privileges, and uploads CAQH as applicable, focusing on accuracy and interpreting or adapting data to conform to defined data field uses.
• Independently prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient processing of each individual application.
• Employs public relations skills and uses discretion in a wide variety of email, phone and in person contacts with internal and external sources for purposes of soliciting information and communicating information essential to the credentialing process and credentials investigations.
• Independently creates and generates data reports from the credentialing database to effectively manage and monitor the credentialing process and their applications.
• Internally audits, organizes and maintains provider files in accordance with established principles of legal documentation and confidentiality.
• Independently maintains tickler system for follow-up of unanswered correspondence. Investigates and resolves matters of significance on behalf of the department and escalates to management as appropriate.
• Organizes and prepares credential files for review by management, clinical department leadership and the Credentials Committee.
• Initiates, processes, reviews and analyzes requests for Additional Privileges, One Time Privileges and Changes of Status.
• Processes Temporary Privileges as applicable and approved.
• Maintains a high degree of discretion and trustworthiness in the handling of confidential information associated with the credentialing process.
• Post Committee reviews and approvals, responsible for assuring file completeness and prompt, accurate and detailed communication regarding final onboarding of new providers, including Post Committee approval letters, Delineation of Privileges (DOP) and communication to providers.