Credentialing Specialist

Under the general supervision of the Business Office Manager and the Administrator this role will be responsible for the coordination, administration, and quality controls of the initial credentialing and privileging processes for all the medical staff. Assignments are planned and executed with considerable independence in compliance with established policies and procedures, bylaws, regulations, and laws. In collaboration with the Director of Nursing and the Administrator, provides consultation to facilities for ongoing facility reappointment and credentialing processes.

• A minimum of three years of experience in managing medical provider credentialing and privileging processes
• Knowledge of credentialing and privileging principles, processes, procedures, and documentation
• Proficient in computer applications (Windows, Microsoft Office)
• Able to communicate effectively both verbally and in writing. Excellent information research skills.

• Prepares, reviews and screens initial medical staff, allied health, new employees and contracted staff credentialing applications for completeness, accuracy, and appropriateness per policy
• Performs external research and conducts verification of all initial applicants
• Utilizing company policies and tools to provide facility guidance relative to the credentialing and privileging processes.
• Stays abreast of and applies knowledge of applicable federal and state laws and regulations and accreditation standards. Recommends pertinent updates and revisions to policies and procedures.
• Maintains the Clinical Services Program Policies and Procedures including revisions and updates
• Manages the distribution and update of Clinical Services Policies and Procedures
• Maintains an electronic achieve of Clinical Services Policies and Procedures
• Provides documentation for surgical and special procedure patients
• Maintains current materials for patient education and consent procedures
• Discusses documentation with patient and family member confirming that instructions are understood, and questions answered
• Answer’s patient and family member questions and refers questions to healthcare professionals when appropriate
• Communicates pertinent information from the physician, support staff, insurance companies and other significant parties to the patient
• Reports regularly to the Business Office Manager about the status of current projects or workflow
• Reviews prequalification for third party payer before date of scheduled admission
• Counsels patients about Facility charges, insurance coverage and the intra-operative experience
• Bills and follows-up with third party payers and patients for services received in accordance with Facility Policy and Procedures
• Accurately prepares the schedule for timely distribution

Equal Opportunity Employer
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