Credentialing Specialist

POSITION SUMMARY

Under the direction of the supervisor, the credentialing specialist is responsible for coordinating all aspects of the credentialing and recredentialing process as well as changes in privileges specialty or demographic information for healthcare professionals practicing within the organization. Responsible for monitoring and managing credentials/recredentialing requirements to ensure the collection of all required renewals are on file within their required time frame.

DUTIES AND RESPONSIBILITIES

• Meticulously reviews, and verify the educational background, licenses, certifications, and work experience of healthcare providers.
• Conduct primary source verification, contacting educational institutions, licensing boards, and previous employers to validate information as needed.
• Perform background checks, including criminal record checks, and ensure they are aligned with our background check standards and policies.
• Ensure that the healthcare providers meet the necessary qualifications and comply with industry, standards and regulatory requirements.
• Advise staff members on renewal dates for licenses and credentials to help ensure that they can continue to work legally without lapses.
• Maintain large up to date databases containing confidential employee information. Uphold and ensure compliance confidentiality and adhere to all HIPAA guidelines. and maintain a strict level of confidentiality for all company policies and procedures.
• Reports any issue in a timely manner to manger, to ensure decision making in accordance with the credentialing and privilege policy and federal state, local and government and health plans standards
• Performs other duties as assigned.

EDUCATIONAL REQUIREMENTS

• Bachelor's degree in marketing, Business or related field of study or any equivalent combination of education and training.
• High school Diploma or higher is required.
• Certified Provider credentialing specialist (CPCS) is required.
• 1-3 years of previous employment as a credentialing specialist with experience in creating databases is required.
• Certified Professional Medical Services Management (CPMSM) is preferred.
• Knowledge of federal and state regulatory agencies and accrediting bodies (CMS, TJC, NCQA, etc.)
• CPR/BLS is required.

Please indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI. (Criminal conviction(s) will not automatically exclude you from consideration for employment).