Credentialing Specialist I

J  o  b    D  e  s  c  r  i  p  t  i  o  n

          Joy                         Care                      Competence                    Respect

Position Summary

Assists with some aspects of the credentialing processes, file development, and completion. Performs certain activities related to credentialing, and re-credentialing including but not limited to, the timely processing of all paperwork and applications necessary to obtain privileges and ensuring that a healthcare facility and its staff's credentials meet government and accrediting agency standards. Assists with the credentialing, privileging, and scheduling of physicians and clinicians at various local entity locations.  Supports effective physician and allied health professional PPE processes.

High School Diploma or GED is required. 

Associate’s or Bachelor’s Degree Health Care Administration or related field is preferred. 

1 years clerical experience is required. 

1 years of experience in healthcare is preferred.

1 years of Hospital Credentialing or Payor Credentialing experience is preferred. 

N/A

Ability to simultaneously handle multiple priorities.

Demonstrates a high level of accuracy, even under pressure.

Excellent organizational skills.

Seeks to acquire knowledge in area of specialty.

Ability to work within tight timeframes and meet strict deadlines.

Strong written and verbal communication skills and listening skills.

Assist with some aspects of the credentialing processes for medical staff and/or payor credentialing, including but not limited to, appointment, reappointment and privileging for the medical and affiliate staff.

Track expirations of pertinent physician data (i.e. licenses, DEA’s, malpractice insurance, ACLS, ATLS, and PALS) of all current medical and affiliate colleague members.

Maintains and updates provider files and database; maintains an up-to-date and organized file system for correspondence, records, and reports.

Follows all regulatory agency guidelines/standards in all areas of credentialing. Maintains appropriate documentation relative to credentialing processes for federal, state or other regulatory bodies.

Responds to inquiries regarding document completion and provider credentialing file completion status.

Assists with processes for documentation review and approval.

Assists with provider on-boarding as assigned.

Assists with formal reports as they relate to area of service.

Support the various functions of the medical staff services and/or managed care department, including but not limited to, physician relations and administrative support and backup coverage.

Serves as a resource to facilitate and assist others to ensure an effective and timely PPE process.

Possess the information, skill, and understanding of the work to be performed.  Actively participates in continuing education opportunities and maintains certifications, licensure as appropriate.

Abides by all safety requirements including demonstrating proper hand hygiene and wearing of Personal Protective Equipment (PPE), if applicable. 

Complies with all standards, policies and procedures including dress code, attendance and punctuality.  Attends required in-services and meetings and completes all mandatory competencies by deadline. Commits to keeping all patient, student or colleague information confidential and maintains ongoing communication and collaboration with team members. 

The purpose of this job description is to provide a summary of the major responsibilities performed by colleagues in this position. Colleagues may be requested to perform tasks other than those specifically presented in this job description.  Variances in job duties performed may exist between facilities, and colleagues may perform other related duties as assigned to meet the needs of the organization.

PHYSICAL, MENTAL AND ENVIRONMENTAL REQUIREMENTS

Physical, Mental and Environmental Requirements Category:

Administrative

Standing

X

Walking

X

Sitting

X

Lifting

X

20 lbs.

Carrying

X

20 lbs.

Pushing

X

20 lbs.

Pulling

X

20 lbs.

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Use of Hands/Dexterity

X

Talking

X

Hearing

X

Eye/Hand/Foot Coordination

X

Extreme Cold

X

Extreme Heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Other