We are a leading healthcare institution committed to delivering exceptional patient care and fostering a collaborative environment for our dedicated team. Join us in our mission to uphold the highest standards of credentialing and ensure the best care for our patients.
Overview
Under the guidance of the Manager of DUHS CVO and the Lead Credentialing Specialist, the Credentialing Specialist plays a pivotal role in ensuring that all medical providers delivering patient care at Health System (DUHS) are properly credentialed. Upholding regulatory standards from organizations such as The Joint Commission, NCQA, CMS, and AAAHC, our specialist ensures compliance and accuracy throughout the credentialing process.
Responsibilities
Process initial applications for DUHS, ensuring adherence to regulatory requirements.
Obtain verification from primary sources for all regulatory requirements, providing timely updates to applicants and maintaining accurate documentation in the credentialing system.
Research and maintain current and accurate data for all providers within the Health System's credentialing database.
Verify practitioner information with primary sources and in accordance with accreditation regulatory standards and state/federal laws.
Maintain a comprehensive credentialing database with up-to-date practitioner information, including licenses, certifications, and renewal periods.
Execute queries for the National Practitioner Data Bank and ensure any received reports are appropriately flagged.
Present complete Health System applications with credentialing verification materials and flag any concerns for further action.
Ensure data integrity within the credentialing database and compliance with relevant entities.
Maintain confidentiality of all provider information and documentation gathered through the credentialing process.
Provide credentialing and privileging verifications in accordance with regulatory standards and laws.
Compose, proofread, and edit formal correspondence and reports for internal and external circulation.
Serve as a credentialing subject matter expert for internal and external contacts.
Apply office standards, policies, and procedures when responding to inquiries from customers.
Organize and maintain resource information and job procedures pertinent to responsibilities.
Prepare various documents, records, and reports as needed.
Perform other duties as assigned.
Requirements
Bachelor's degree or equivalent experience in Managed Care or Medical Staff Credentialing/Privileging.
One year of experience in a Medical Staff/Managed Care credentialing office. Lead Credentialing Specialist Experience: Three years of experience in a similar role.
Certification by NAMSS (CPCS and/or CPMSM) preferred.
Diversity And Inclusion
We are dedicated to creating a community that embraces diversity and fosters inclusivity. We believe that the diverse perspectives, backgrounds, and experiences of our team members enrich our collective success. We are committed to providing equal employment opportunities to all individuals regardless of age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Physical Requirements
Certain positions at University and Health System may include essential job functions that require specific physical and/or mental abilities. Additional information regarding reasonable accommodation requests will be provided by each hiring department.
Join us in our pursuit of excellence and make a difference in healthcare. Apply now to be part of our dynamic team!
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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