Credentialing Specialist Position Summary: The Credentialing Specialist is responsible for all aspects of the credentialing and reappointment process for OBHG clinicians. The Credentialing Specialist will process applications, verify information, research application details, and assure processes are in accordance with medical staff bylaws. The Credentialing Specialist will provide consistent, accurate, and timely credentialing support, enhancing the organization’s ability to provide professional services by ensuring clinicians are credentialed at all hospital programs in which they are intended to work.

I. Credentialing Specialist Responsibilities: Essential

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Privileging and Reappointments

• Responsible for the processing and preparation of the applications for privileges on Hospital Medical Staff:
  • Examines, researches, enters data, files, and gathers all required documentation from clinicians to support the credentialing process.
  • Completes clinician credentialing and reappointment applications; monitors application progress and follows up as needed.
  • Assists when needed in obtaining verifications for medical school, residency, fellowship, NPDB, work history, peer references, etc.
  • Maintains consistent communication with clinicians during the credentialing process as the application progresses through various phases of approval.
  • Tracks critical dates of the hospital privileging process including Credentialing Committee, Medical Executive Committee, and Board meeting to meet credentialing timelines.
• Establishes and maintains professional relationships with clinicians, Medical Staff Office personnel, OBHG support team, and other affiliates.
• Manages multiple clinician credentialing requirements simultaneously.
• Adheres to the standards of hospital by-laws for verification of clinician credentialing requirements, including but not limited to licenses, certifications, registrations, and educational degrees.
• Maintains and updates internal database (CRM) for OBHG clinicians and candidates regarding the credentialing process.
• Escalates non-responsiveness of clinician or Medical Staff Office to Supervisor and internal stakeholders for resolution.
• Coordinates with staffing agencies in the credentialing process for locum and per diem clinicians, providing assistance where needed.

Clinician Record Management

• Responsible for the maintenance and accuracy of electronic clinician employee credentialing files.
• Collects and processes significant amounts of documents required for verification.
• Maintains and updates databases for both practitioners and facilities.
• Compiles and maintains current and accurate data for clinicians, including current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents.
• Tracks medical licensure and DEA certification for all clinicians to ensure timely renewals.
• Enrolls new clinicians in National Practitioner Database – Continuous Query.
• Maintain and update reports as requested.
• Maintains data for clinicians in Sharepoint.

Clinician Onboarding

• Responsible for scheduling hospital orientation and coordinating with clinicians.
• Responsible for communicating hospital training requirements related to credentialing or reappointment to clinicians.

Operational Support

• Participates on internal Team Calls to provide updates on candidates in the credentialing process.
• Participates on Program Implementation Calls to provide updates on candidates in the credentialing process.
• Collaborates with Privileging Team to obtain Medicaid and Medicare signature pages and documentation of such in the Medkinetics database.

Performs other duties as assigned.

II. Essential Skills/Credentials/Experience/Education for Credentialing Specialist Position

• Ability to organize and prioritize work and manage multiple priorities.
• Effective time management and ability to meet regular time sensitive deadlines.
• Ability to produce work in high quantity and quality.
• Excellent written and verbal communication skills, including letters, memos, and emails.
• Excellent attention to detail.
• Works with initiative, energy, and effectiveness in a fast-paced environment.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with clinicians, management, medical staff office personnel, and other contacts outside of the organization.
• Knowledge of clinician credentialing criteria and processes in accordance with NCQA, JCAHO standards, NPDB guidelines, and general licensing requirements.
• A minimum of a High School Diploma is required; an Associate’s Degree is preferred.
• Ability to uphold the principles of compliance as outlined by the company.

III. Preferred Skills/Credentials/Experience/Education for Credentialing Specialist Position

• Certified Provider Credentialing Specialist (CPCS) by the National Association of Medical Staff Services (NAMSS) preferred.
• Two years of credentialing experience.
• Strong computer skills, proficient in Word, Excel & Access.
• Preferred understanding of medical terminology.
• Preference will be given to candidates who have worked in a Medical Staff Office.

IV. Mental and Physical Demands (per ADA guidelines) of Credentialing Specialist Position

Physical Demands:

• Sitting for long periods of time. Occupation requires this activity more than 66% of the time (2.6 hrs/day).
• Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
• Regularly required to use computer keyboard, mouse and telephone.

Hourly Compensation: $25 - $30 per hour

Benefits: Medical, Dental, Vision, Life, Disability, Supplemental Medical, Supplemental Life, Legal, ID Shield, EAP, 401(k), Paid Time Off