Senior Credentialing Specialist

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

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