Position : Credentialing Specialist

Location : New York, NY

Duration : 2 Months

Job Description :

We are seeking a detail-oriented and experienced Credentialing Specialist to join our team. The Credentialing Specialist plays a vital role in ensuring the accuracy and integrity of provider credentialing, privileging, and compliance processes.

This position requires a thorough understanding of credentialing standards, regulatory requirements, and hospital policies.

Responsibilities :

• Facilitate all aspects of provider credentialing, including initial appointment, reappointment, and clinical privileging for Medical Staff, Allied Health Professionals, and other providers as outlined in corporate policies and hospital bylaws.
• Utilize MDStaff credentialing software application to perform and monitor all credentialing and background checks, ensuring accuracy and data integrity.
• Conduct credential audits to verify compliance with accreditation standards, regulatory requirements, and internal policies.
• Interpret and ensure compliance with accrediting and regulatory agencies' standards, including but not limited to The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and Centers for Medicare & Medicaid Services (CMS).
• Develop and maintain a working knowledge of statutes and laws related to credentialing, privileging, and provider enrollment.
• Collaborate with various departments, including Human Resources, Medical Staff Office, Quality Assurance, and Compliance, to coordinate credentialing activities and ensure timely completion of credentialing processes.
• Communicate effectively with providers, hospital staff, and external agencies to obtain required credentialing documentation and resolve credentialing-related issues.
• Maintain accurate and up-to-date credentialing files and databases, ensuring confidentiality and security of sensitive information.
• Assist in the development and implementation of credentialing policies, procedures, and training programs to promote compliance and efficiency.
• Participate in internal and external audits, providing documentation and support as needed to demonstrate compliance with credentialing standards and requirements.

Qualifications :

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Minimum of two years of experience in provider credentialing and privileging, preferably in a healthcare setting.
• Strong knowledge of credentialing standards, regulations, and accreditation requirements, including TJC, NCQA, and CMS.
• Proficiency in using credentialing software applications, such as MDStaff, and Microsoft Office Suite.
• Excellent organizational, analytical, and problem-solving skills, with meticulous attention to detail.
• Ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines in a fast-paced environment.
• Commitment to maintaining confidentiality and handling sensitive information with discretion and professionalism.
• Willingness to adapt to changes in policies, procedures, and technology to ensure compliance and efficiency.
• Certification in Medical Staff Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.

Last updated : 2024-05-04