Credentialing Specialist

POSITION SUMMARY: Under general supervision, coordinates and administers all aspects of the credentialing process for physicians, professional providers, and network practitioners. Initiates and coordinates the reappointment process for existing providers within assigned areas; ensures accuracy and completeness of all documentation; serves as initial point of contact to providers on day-to-day credentialing issues. 

RESPONSIBILITIES:
* Reviews and screens initial provider credentialing applications for completeness, accuracy, and compliance with federal, state, local and QCP regulations, guidelines, policies, and standards. 
* Performs external research and conducts verification of all applicant licensure, education and training, relevant past employment, and affiliations; assesses compliance with risk exposure criteria, and advises management on eligibility for temporary privileges consideration. 
* Interprets federal, state, local, and government/insurance agency regulations and guidelines, as well as QCP policies and advises providers and management on compliance issues as appropriate. 
* Provides support and follow up on matters arising from committee meetings. 
* Interfaces with providers on day-to-day credentialing and privileging issues as they arise. 
* Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external agencies as appropriate. 
* Performs internet, agency, and/or internal research as appropriate to assess past high risk/liability activity with respect to medical staff; analyzes and prepares finding and submits to management. 
* Maintains confidential files on all provider credentials and other pertinent information to ensure accurate up to date records.
^ Ability to use independent judgment and to manage and impart confidential information. 
* Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation. 
* Ability to analyze, interpret, and draw inferences from research findings, and prepare reports. 
* Database management skills. 
* Working knowledge of clinical and/or hospital operations and procedures. 
* Information research skills. 
* Program planning and implementation skills. 
* Knowledge of computer spreadsheets and other related applications. 
* Knowledge of provider credentialing/accreditation regulations, policies, guidelines, and standards. 
* Ability to communicate effectively, both orally and in writing. 
* Ability to make administrative/procedural decisions and judgments. 
* Other duties as assigned.

REQUIRED QUALIFICATIONS:
High school degree or equivalent. 
Bachelor of Science in Communications, Marketing or Healthcare Administration preferred. 
Experience in quality assurance, credentialing and/or medical records preferred. 

GO TO WEBSITE AND APPLY: 
https://www.qualitycarepartners.com/About-Us/Job-Opportunities/