Credentialing And Verification Specialist

Overview

Assist the Manager, Credentialing and Medical Staff Services, in the credentialing and verification upon initial application and reapplication to Memorial Health Hospital Medical Staff. Works with their leader to improve the credentialing and verification process, streamline hospital privileging and support managed care credentialing.

Qualifications

Education:

• Bachelor's degree in business or health related field is desirable.

Licensure/Certification/Registry:

• Successful completion (or on track to sit for the exam within 3 years of assuming this position) and ongoing maintenance of the Medical Services Management (CPMSM) and/or Provider Credentialing Specialist (CPCS) certifications.

Experience:

• A minimum of 3 years' experience in medical staff services is preferred.

• Proven experience in maintaining collegial working relationships with physicians, allied health professionals and members of the leadership team.

Other Knowledge/Skills/Abilities:

• Working knowledge of medical terminology is required.

• Excellent verbal and communication skills are required.

• Proven team player.

Responsibilities

Responsible for credentialing Medical Staff initial applicants and reapplicants to Memorial Health Hospitals under the oversight of the Manager, Credentialing and Medical Staff Services.

Supports Memorial Health Managed Care with their provider credentialing for internal and external managed care credentialing needs under the oversight of the Manager, Credentialing and Medical Staff Services.

Overseas the practitioner credentialing database ensuring accurate and current information is available to all stakeholders.

Participates in the development and implementation of credentialing processes and procedures.

Audits, assesses, procures, implements, effectively utilizes and maintains practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) by analyzing the needs and resources of medical services/credentialing.

Supports MH affiliate hospital Medical Staff Offices in the privileging process.

Ensures that policies, procedures and mechanisms to support the credentialing process in accordance with Medical Staff Bylaws, Rules and Regulations and in compliance with standards of all external regulatory and accrediting bodies.

Provides administrative support required to ensure effective management and coordination of the medical/allied health professional staff credentialing processes. Assists the Manager, Credentialing and Medical Staff Services in the management of data to support the peer review process.

Maintains cooperative and supporting working relationships with all individuals who have involvement with organized the Credentialing and Verification Office.

Maintains a commitment to the MHS mission vision, values, goals and behavioral standards.

Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.