Credentialing Specialist

Job Description

Type: Temp to Permanent (Full-Time)

Shift: Days

Hours: 8:30 AM – 4:30 PM or 9am-5pm

Job Summary:

The Medical Affairs Credentialing Specialist processes credentialing and re-credentialing applications of physician and allied health practitioners. The Specialist reviews applications, conducts primary source verifications, prepares appointment letters, and maintains Midas database. The Credentialing Specialist contacts internal and external medical office staff, licensing agencies, and insurance carriers to complete credentialing applications.

The Credentialing Specialist should have a good working knowledge of commonly used concepts, practices, and procedures relative to NCQA and Joint Commission standards.

Responsibilities:

• Process initial and recredentialing applications for physicians and allied health professional.
• On a monthly basis, track expiring licensure and send reminder notices to practitioners.
• Collect and verify background information for practitioners using primary and secondary sources by querying various websites.
• Enter and maintain practitioner information in Credentialing database, as appropriate
• Maintain confidential credentials files and electronic medical staff databases.
• Assist with preparation of agenda for Credentialing Committee meetings and distribution of minutes to Committee members.
• Provide support during Managed Care, Joint Commission and DOH audits
• Additional tasks, as applicable

Requirements:

• 3-5 years’ experience in Medical staff Services and/or Credentialing
• CPCS Certification preferred
• High School diploma or Equivalency required
• B.S. Preferred
• Excellent written and verbal communication skills
• Excellent technical skills
• Excellent interpersonal skills