Credentialing Specialist I - Medical Staff

SUMMARY: 

Verifies medical training, experience and other attributes required of medical health care providers. Ensures the completion of files and monitors expired documents during the members’ appointment period.

ESSENTIAL FUNCTIONS:

·         Assists Credentialing Specialists and Leadership with the credentialing and recredentialing process.

·         Reviews applications and other data for accuracy and completeness.

·         Performs and collects primary source verification and other documents needed including follow-up activities of initial and reappointments applications.

·         Enter credentialing and privileging data timely and accurately into the credentialing database.

·         Ensures good working relationships with clinical departments, Medical Staff leadership and professional agencies.

·         Assists in compliance with the accrediting and regulatory agencies regarding credentialing, while developing and maintaining a working knowledge of the required statutes and laws.

·         Answers phones, assist with committee support, make copies, prepare mailings, and maintain files.

• Adheres to TMCH organizational and department-specific safety, confidentiality, values, policies, and standards.

·         Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION: High school diploma or general education degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE:  None required.  One (1) year experience performing medical staff credentialing or similar related tasks preferred.

LICENSURE OR CERTIFICATION: None required.

KNOWLEDGE, SKILLS, AND ABILITIES: 

• Knowledge and ability to understand what credentialing of medical health care providers entails.
• Knowledge and ability to understand, policy and procedures, regulations, statues, and laws as it relates to documents required for credentialing.
• Ability to organize and prioritize all assigned tasks and workloads in a busy work environment.
• Ability to brief leadership in a timely manner on status of workload, projects, priorities, barriers, or issues to ensure assignments are on track.
• Skill in the use of Microsoft Office products, especially Word and EXCEL.
• Ability to review and monitor various forms of detailed credentialing information to ensure compliance with departmental procedures.
• Ability to draft reports, business correspondence, and procedure manuals.
• Ability to respond professionally to departmental inquiries from internal or external customers in a timely manner. This includes understanding the escalation path for more complicated topics.