Credentialing Specialist

The Credentialing Specialist works as a part of the administrative team and is responsible for ensuring that healthcare professionals and the organization are qualified and meet the necessary requirements to provide services to patients. The individual will verify and organize all aspects of the credentialing and privileging processes and maintain current files on providers, pharmacists, technicians, nurses, medical assistants, and other staff as deemed necessary.

Functions include but are not limited to processing credentialing applications, performing primary source verifications, coordinating privileging forms, ensuring documents in credentialing software stay updated and organized, and staying updated on guidelines and applicable state and federal requirements.

Essential Duties and Responsibilities:

• Maintains compliance with all regulatory and accrediting institutions.
• Responsible for gathering and verifying highly confidential and sensitive healthcare professional credentials consistent with policies, procedures, and accreditation standards.
• Manages staff credentials and licenses and ensures accurate data entry to confirm the integrity of credentialing and privileging information within the recredentialing software.
• Works directly with Johnson Health Center (JHC) staff regarding all credentialing and privileging needs and updates and responds to internal and external inquiries in a timely manner.
• Monitors and advises healthcare professionals and leadership on expiring licensure, board, and professional certifications, and other expirable documents within the prescribed timeframe.
• Screening applications and supporting documentation to confirm eligibility and ensure completeness of the application in preparation for the verification process.
• Collects information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
• Maintains credentialing software to track and manage healthcare professional credentials.
• Identifies discrepancies in information and conducts timely follow-ups.
• Collaborates with Compliance, HR, Billing, and Central Verification Officer (CVO) to facilitate and ensure smooth hand off during the credentialing process, as well as informing them of credentialing issues. Ensures proctoring is completed and signed off on all new providers and other providers as necessary.
• Provides recommendations to the Medical Management Committee on new hire credentialing based on a tiered system to identify any credentialing concerns.
• Monitors credentialing software to ensure each provider has the appropriate and up-to-date privileges.
• Tracks facility licenses within the software, provides advanced reminders to the proper leadership of upcoming renewals, and assists as needed.
• Performs other duties as assigned.

Other Functions:

• The staff member will abide by the Code of Conduct as documented in the Corporate Compliance Manual.
• Must demonstrate a personal and professional commitment to JHC and its mission.
• Treats all patients and staff with dignity and respect, mindful of the cultural differences of the diverse population we serve.
• Management may modify, add, or remove any job functions as necessary, or as changing organizational needs require.

JHC Core Values:

Staff members must actively demonstrate dedication and commitment to the core values of JHC.

• Respect – We value and respect each patient, their family, ourselves, and each other.

Every individual associated with Johnson Health Center will be treated with dignity and respect. We value and respect people’s differences, show empathy to our patients, their families and each other, and work collectively to build Johnson Health Center as a health center and an employer of choice.

• Integrity – We are committed to doing the right thing every time.

Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical behavior. We are accountable for the decisions we make and the outcome of those decisions.

• Excellence – We will pursue excellence each and every day in activities that foster, teamwork, quality improvement, patient care, innovation, and efficiencies.

At Johnson Health…