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.