Credentialing Specialist

Overview

JOB SUMMARY: 

Provides clerical support for the medical staff including timely compilation and coordination of all credentialing and reappointment processes, coordinating medical staff related meetings, maintaining all medical staff files, and being part of a team that aspires to ensure quality, timeliness and clear communication. 

EDUCATION/EXPERIENCE: 

• High school diploma and two years' administrative/clerical or healthcare experience. 
• Associate's degree with certification in Medical Office administration preferred. 
• Medical staff credentialing experience preferred. 

LICENSURE, CERTIFICATION, and/or REGISTRATION: 

• NAMSS certification preferred. 

ESSENTIAL FUNCTIONS: 

1. Performs primary source verification for both initial appointment/credentialing and re-credentialing. 
2. Conducts annual monitoring of medical licensure of all credentialed providers and maintains current, accurate documentation relative to credentialing files. 
3. Monitors and confirms focused evaluation (FPPE) completed at time of initial appointment for all new providers. 
4. Assures appropriate departments are notified of approval of new providers. 
5. Verifies previous appointments as providers who have left the Medical Center. 
6. Monitors and confirms ongoing evaluation (OPPE) completed two times annually for all active providers. 
7. Actively participates in all audits, i.e. Managed Care, Medicare, state licensure, etc. 
8. Actively participates in all surveys, i.e. Joint Commission, Medicare, all disease specific surveys, etc. 
9. Provides support for medical staff including preparing and distributing agendas and related materials for medical staff departmental and committee meetings, Medical Staff Executive Committee and Full Medical Staff Meetings. 
10. Supports and assists affiliate hospital medical staff offices. 
11. Provides information relative to medical staff and allied health professionals to other departments and external agencies, as appropriate, with due confidentiality, in a timely manner. 
12. Provides support for updating and revising medical staff documents, i.e., Bylaws, Rules and Regulations. 
13. Maintains a working knowledge of the Medical Staff Bylaws, Rules and Regulations, Credentialing Manual, and Fair Hearing Plan. 
14. Remains current with Joint Commission Medical Staff Standards, state and federal laws related to medical staff. 
15. Prepares medical staff dues statements and collects dues. Maintains medical staff checking account and makes deposits as needed.