JOB OVERVIEW: Under the supervision of the Physician Services Director, the Credentialing Specialist is responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care at Artesia General Hospital and Clinics. Responsible for ensuring providers are credentialed, appointed, and privileged. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Maintains rosters, expiable and provides support for Medical Staff meetings.

This position ensures all health care professionals are appropriately credentialed, which includes the duty of maintaining current information on file and within the credentialing database. This position primarily works independently, but frequently coordinates with other team members. Main functions include: Maintain up-to-date data for each provider in credentialing databases and online systems;

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

1. Compiles and maintains current and accurate data for all providers in online credentialing databases and system.
2. Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
3. Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files
4. Coordinates and communicates the approval of appointments/reappointments and resignations as well as the assignment of temporary privileges in a timely and thorough manner
5. Processes applications and re-appointments online, checking for completeness and accuracy.
6. Responsible for maintenance and distribution of current Medical Staff roster.
7. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
8. Tracks license and certification expirations for all providers to ensure timely renewals.
9. Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) education, training, experience, and licensure and/or other sources as required based on federal standards, and company credentialing policies. Further research as necessary.
10. Coordinate and maintain the process of provider insurance enrollment services for new and existing medical staff.
11. Ensures compliance with internal policies, regulations, and standards.
12. Completes requests from other facilities regarding current and past members of the Medical Staff and Advanced Practice Professionals.
13. Prepare and scan credentialing/re-credentialing files and other credentialing documentation, as needed.
14. Ensure timely renewal of licenses and certifications.
15. Maintains record of emergency department call schedules and physician coverage correspondence for medical staff to the involved medical staff members and Emergency Room.
16. Assists with new practitioner onboarding & orientation
17. Assists with Medical Staff meetings, minute taking as needed. Accurately transcribes proceedings of all medical Staff meetings within one week following each meeting.
18. Assists with Scheduling of rooms, requests food, and sets up any needed equipment for department/committee meetings.
19. Ensures Medical Staff Lounge is maintained at all times.
20. Ensures the process of credentialing and other department functions are performed in accordance with bylaws, the DNV and CMS standards
21. Responds to requests from other departments and facilities regarding providers credentialing documents.
22. Assists with obtaining malpractice insurance coverage for all providers.
23. Maintain working knowledge of standards and State and Federal standards and regulations related to credentialing
24. Pick-up, process and distribute incoming and outgoing mail as necessary.
25. Participates in the Medical Staff portion of the CMS/Regulatory surveys and others as necessary
26. Maintains confidentiality of provider information.
27. Performs other duties as assigned.

QUALIFICATIONS:

Education:

1. High school diploma or equivalent.
2. Associate degree preferred.

SKILLS:

1. Knowledge and understanding of the credentialing process.
2. Knowledge of basic medical terminology.
3. Broad knowledge and familiarity with healthcare related regulatory and accreditation requirements.
4. Excellent verbal/written communication skills including, letters, memos and emails and problem-solving skills required.
5. Must have good organizational skills and attention to details.
6. Ability to research and analyze data.
7. Ability to work independently, prioritize, manage multiple tasks, and make responsible decisions.
8. Must demonstrate self-motivation.
9. Ability to perform duties in a timely manner with accuracy and attention to detail.
10. Proficient use of Microsoft Office applications (Word, Excel, PowerPoint) and internet resources.

The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.