Credentialing Specialist

Job Summary: The Credentialing Specialist is responsible for processing initial applications and reappointment applications to credential and privilege the medical staff at affiliated hospitals in the WMCHealth Network.  Performing primary source verification and ensuring that all physicians, residents, fellows, dentists, and allied health professionals are clinically qualified to perform the privileges requested are major responsibilities of this position.  Work is performed in compliance with detailed requirements, guidelines, and deadlines of DNV, Joint Commission, NYS DOH, Centers for Medicare & Medicaid Services, National Committee for Quality Assurance (NCQA), Westchester County Health Care Corporation Board of Directors, accrediting organizations and regulatory agencies.   Does related work as required, including project support for the balance of the Department of Clinical and Academic Affairs. Works with colleagues from other hospitals and business units in the WMCHealth Network.

Responsibilities:

• Able to effectively work on multiple projects in a fast-moving environment, to make progress and reach sequential, interim target completion dates
• Works within the credentialing software to perform primary source verification of professional education, training and employment, clinical licensure, board certifications, Drug Enforcement Administration (DEA) registration, infection control, and other relevant items.
• Queries National Practitioner Database (NPDB) and other relevant national databases and organizations, conducts reference checks and obtains and reviews malpractice history
• Clear, professional communication with internal physician leadership and external applicants
• Reviews documentation, updates database and takes application from start to completion;
• Effectively communicates requests and status of applications, missing items required for completion, next steps to applicants;
• Tracks and follows up on expired documents;
• Maintains confidentiality of sensitive information gleaned through the application process, and through the course of credentialing work;
• Compiles statistical information and data on medical staff and allied health professionals
• Participates in staff meetings, training sessions, committee meetings and other meetings as needed;
• Other duties as assigned.

Qualifications/Requirements:

Experience: Five years of experience in project coordination, administrative support, and/or medical staff credentialing preferred.

Education: Bachelor’s Degree preferred; High school or equivalency diploma required.

 Licenses / Certifications:  Certified Professional in Credentialing Services encouraged, through National Association of Medical Staff Services (NAMSS). If not currently certified, future certification as a goal.

Other:  Ability to learn quickly; be detail-oriented, solution-oriented.  Strong writing and speaking skills. ability to assemble and organize data; ability to work with department leadership to prioritize and meet deadlines; ability to effectively use Microsoft Office suite of products (Word, Excel, Powerpoint)computer applications such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to communicate effectively both orally and in writing; ability to establish and maintain effective working relationships with professional medical, technical, managerial, clerical and non-skilled personnel; attention to detail; sound and mature judgment; flexibility.