Corporate Credentialing Specialist

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Position Summary

The Credentialing Specialist coordinates and organizes ongoing credentialing and privileging of physicians and advanced practice professionals. Responsible for review, analysis and follow up of credentialing and privileging applications, maintaining strict confidentiality. Ensures compliance with federal and state agencies, organizational policies, accrediting and regulatory agencies, and contractual requirements for delegation agreements.

Position Responsibilities

• Coordinates and organizes credentialing/privileging requests/modifications for an SHC facility and supports providers requesting privileges at affiliate locations. Ensures evidence of education, training, and experience to determine eligibility for requested privileges, membership.
• Verifies and documents credentials and expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards; as well as manages and documents all communication with providers and primary facilities to ensure notification of upcoming expirables. Keeps record of all credentialing activities in the credentialing database to ensure files reflect current status.
• Recognizes, investigates, and validates discrepancies and adverse information obtained; obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance.
• Responsible for confidentiality and data entry, maintenance, and analysis of clinical provider information within database per established guidelines to ensure complete electronic credential file to support provider enrollment and delegation requirements.
• Collaborates credentialing, OPPE, FPPE and privileging activities with SHC Medical Staff Offices to ensure timely approval process of governing bodies, participation in accreditation surveys and audits, to include verification of appropriate drug and criminal background screenings. Prioritizes workload to meet deadlines.
• Maintains current knowledge of accreditation standards (TJC, NCQA), state and federal regulations, as well as SHC medical staff bylaws, regulations, and procedural rules.

Education

• High School Diploma or equivalent (required)
• Associates Degree in applicable field (highly preferred)
• Bachelor's Degree in applicable field (preferred)

Experience

• Minimum of 3 years of credentialing experience, preferably in a Centralized Verification Office (CVO), Medical Staff Office, or integrated health system required.
• Experience with MD Staff or relevant credentialing database system(s) required

Certifications and Licensures

• Certified Provider Credentialing Specialist (CPCS), Certified Professional in Medical Services Management (CPMSM) or equivalent certification (required) If candidate is not currently certified, CPCS will be required within 24 months of hire, or upon eligibility

Additional Knowledge and Skills

• Problem solving and analytic skills.
• Written and verbal communication and organization skills.
• Ability to prioritize and maintain organization in a fast-paced environment, with conflicting deadlines.
• Must be flexible and able to adapt to an ever-changing environment in a productive manner.
• Detail oriented
• Self-starter, innovative, resourceful and results-oriented
• Work independently but also have a strong commitment to being a team player
• Adheres to professional confidentiality standards in accordance with legal, ethical, and hospital policies

Technical Competencies

• Data entry skills. including ability to navigate a translational database to enter and retrieve information.
• Must be able to demonstrate competency in Microsoft Office Applications (Excel, Word, PowerPoint, Outlook, and Teams)

Compensation is determined based on years of relevant experience and departmental equity.