Credentialing Specialist

Montgomery, AL 36117

Posted: 05/01/2019 Industry: Medical Pay Rate: $36,000

We are looking for a detail oriented, dedicated professional to join the team of a local healthcare association as a Credentialing Specialist!

The Credentialing Specialist is responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for health professionals contracted with APHCA’s Credentials Verification Organization (CVO). The Credentialing Specialist also ensures accurate interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

Responsibilities will include:

  • Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  • Conducts thorough background investigation, research and primary source verification of all components of the credentialing file.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Prepares credentials file for completion and presentation to CVO clients, ensuring file completion within time periods specified.
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
  • Conducts ongoing audits on files and policies and procedures to ensure compliance with accrediting standards.
  • Utilizes the credentialing database to perform query, report and document generation.
  • Monitors the initial, reappointment and expirables process for all medical staff, allied health professional staff, other health professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, HRSA, FTCA, CMS, federal and state rules and regulations), as well as organizational policies and procedures, and delegated contracts.
  • Provides training and technical assistance support as needed.

Qualified candidates for the Credentialing Specialist will meet the following requirements:

  • Minimum of two (2) years of experience in medical staff or managed care credentialing 
  • NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively seeking certification and ability to become certified within one year.
  • Ability to communicate effectively, both orally and in writing.
  • Strong computer skills in current Microsoft Office applications (i.e. Word, Excel, PowerPoint, Publisher)
  • Program planning and implementation skills.
  • Knowledge of related accreditation and certification requirements.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Informational research skills.
  • Ability to use independent judgment to manage and impart confidential information.
  • Database management skills including querying, reporting, and document generation.
  • Ability to make administrative/procedural decisions and judgments.

This is a Try & Hire position.

Salary for this opening is $36,000. 

All offers of employment are contingent on a background check and drug test.

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