Overview
The Senior Credentialing Specialist contributes to the ongoing achievement of the organization's goals through ensuring providers are credentialed using vetted processes and procedures. Identifies, analyzes, and resolves information, discrepancies, and time gaps that could adversely affect a facility's ability to credential and privilege providers. Partners with medical staff, credentialing and privileging committees, and other key stakeholders to ensure compliance with credentialing standards. Responsible for maintaining accurate and comprehensive data in the credentialing software.
The Senior Credentialing Specialist must have overall knowledge of the credentialing and privileging process, know the required credentials for health care professionals and can utilize the appropriate resources to complete Prime Source Verification (PSV) and databank queries. Senior Credentialing Specialists demonstrate a thorough knowledge on credentialing policies, guidelines, and regulations for the CVO credentialing process.
Duties & Responsibilities
Handles and oversees the processing of provider applications and re-applications
Maintains accurate provider profiling system data
Communicates with providers concerning credentialing status
Responds to requests for provider information
Enforces regulatory compliance and quality assurance
Support, in conjunction with the QA Team, any adverse action activities in accordance with regulations and policies
Prepare documentation, conduct, and conclude credentialing and privileging
Work, in conjunction with leadership, to identify potential 'pitfalls' in the CVO credentialing process
Meet productivity standards as outlined in CVO and client metrics Skills Required
Strong interpersonal skills-works well with a team
Strong oral and written communication skills
Strong conflict resolution skills
Exceptional attention to detail
Exceptional analytical skills
Customer interaction experience
Qualifications Required:
Bachelor's Degree and/or equivalent work experience
3 plus years of experience in medical credentialing
Strong knowledge of industry standards, to include but not limited to: TJC, NCQA, AAAHC and DNV
Strong knowledge of the Microsoft office suite to include Excel
Affinity to multi-task
Certification Preferred: CPCS Min
USD $24.00/Hr.Max
USD $28.00/Hr.Originally posted on Himalayas
