CREDENTIALING SPEC - NON-CERT/MVH/FT

Title: Credentialing Specialist, Non-Certified

Unit: Premier Health CVO

Hours: Mon-Fri, 7a-3:30p

Facility: MVH

Position Summary:

Responsible for providing credentialing and administrative support of the credentialing process including the processing of new applications, requests for temporary privileges, biennial reappointments in accordance with Med Staff Department and Committee structure: assumes the responsibility for credentialing all individuals seeking Medical Staff Privileges. Responsible for provider enrollment with core payors: responsible for maintaining and updating all appointees’ expirables using database management skills: To provide support and analyze data in the reappointment process. Utilize and maintain CAQH applications for employed providers. Implement and maintain moderately complex computer-based systems associated with the medical staff.

Essential Duties & Functions:
Manage all aspects of Premier Health Central Verification Organization (PH CVO) credentialing and re-credentialing verification process for assigned clients to meet standards and requirements of client, Premier Health CVO, NCQA, TJC, URAC, CMS, federal and state, and other regulatory or accreditation bodies, including:

1. Collect and analyze verification information and documents.

2. Perform related data entry/maintenance into the enterprise credentialing software in a timely and accurate manner to maintain and monitor credentialing program operations and to ensure consistent, accurate data is available to multiple downstream applications.

3. Ongoing monitoring, verification, and database maintenance of practitioner expirable credentials, including license, DEA registration, malpractice insurance, board certification, and CPR certification in accordance with all applicable regulatory standards.

4. Assist other Credentialing staff during high volume periods to ensure completion of

credentialing and re-credentialing requirements.

5. Evaluate work prioritization and assignments to ensure timely credentialing and re-credentialing processes.

6. Communicate with clients and/or applicants throughout credentialing process.

7. Liaison with Medical Staff Coordinators, colleagues and Premier Health clients.

8. Meet or exceed NCQA standards and CVO policies to maintain CVO certification and delegation with

Managed Care organizations.

9. Cross coverage with other CVO Credentialing Specialists.

10. Liaison with practitioners, clinical departments, and clients regarding areas of responsibility.

Education:
Minimum Level of Education Required: High School completion / GED
Additional requirements:Preferred educational qualifications: Associate degree

Licensure/Certification/Registration:
National Association of Medical Staff Services (NAMSS) certification as a Certified Provider Credentials Specialist (CPCS), or as a Certified Professional in Medical Services Management (CPMSM) required after three years of employment.

Experience:
Minimum Level of Experience Required: 1 - 3 years of job-related experience

Prior job title or occupational experience: Medical staff privileging/credentialing processes or managed care provider credentialing preferred.

Preferred experience: Medical staff privileging/credentialing processes or managed care provider credentialing preferred. Experience using CAQH database is preferred.

Other experience requirements: Cactus or credentialing software experience is required.

Knowledge/Skills:
Demonstrated proficiency in Microsoft Word, database management and basic computer knowledge.

Knowledge of medical terminology.

Possess good communication skills (writing and verbal), diplomacy, tact, attention to detail and problem solving skills.

Must be able to work with all levels of the organization which includes practitioners, administration and hospital staff.

Coordinate, organize, prioritize, and handle multiple projects with many disruptions.

Highly motivated and able to work independently in a high-volume department.

Willingness to adapt to flexible work schedules. Loyal, reliable, tactful, honest and discreet, maintaining confidentiality at all times.

Exhibit professional appearance and demeanor.