Job Description

Job Description

Position: Medical Staff Credentialing Specialist and Coordinator

The Medical Staff Credentialing Specialist and Coordinator assists the Medical Director, Hospital Administration, and the Medical Staff Team by coordinating the activities of the organized medical staff. This includes all aspects of the services provided, including accreditation compliance, credentials verification, medical staff committee support, and maintenance of medical staff policies, procedures, and bylaw development.

Shift and Status:

• Full-Time, non-exempt position

• Monday – Friday

• No weekends

• No Holidays

• Competitive pay and benefits package including vacation and sick time, health, dental, and vision, as well as a pension and retirement plan

Position Summary:

Responsible for all aspects of the credentialing, re-credentialing, and privileging processes for all licensed clinical staff members who provide patient care. Ensures providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintains up-to-date information for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications.

Duties and Responsibilities:

• Compiles and maintains current and accurate data for all providers.

• Completes provider credentialing and re-credentialing applications, monitors applications, and follows up as needed.

• Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.

• Maintains corporate provider contract files.

• Maintains knowledge of current health plan and agency requirements for credentialing providers.

• Sets up and maintains provider information in online credentialing databases and systems.

• Tracks license and certification expirations for all providers to ensure timely renewals.

• Ensures practice addresses are current with health plans, agencies, and other entities.

• Audits health plan directories for current and accurate provider information.

• Completes credentialing/re-credentialing application packets for hospitals, insurance carriers, and government programs. Applies for NPI numbers for new providers, provides NPI numbers to physician offices and insurance carriers as requested. Enrolls new and updates existing providers in CAQH (on-line clearing house) according to guidelines.

• Initiates malpractice coverage application process for new providers.

• Coordinates with Accounts Payable to ensure fees and premium payments are submitted for licenses, DEA certificates, and malpractice coverage.

• Monitors and maintains a database of all Continuing Medical Education credits obtained or programs attended by clinical staff, records additional certification earned by providers.

• Maintains confidentiality of provider information.

• Provides credentialing and privileging verification.

Requirements and Qualifications:

• Associate’s Degree or Certified Provider Credentialing Specialist (CPCS).

• A minimum of 2-3 years of credentialing experience preferred.

• Excellent verbal and written communication skills; ability to relate well with people of diverse backgrounds, training, and experience.

• Proficiency with medical practice software programs, familiarity with credentialing requirements of hospitals and insurance carriers.

• Understanding of malpractice insurance coverages and policies.

• Knowledge and understanding of the credentialing process.

• Ability to organize and prioritize work and manage multiple priorities.

• Ability to research and analyze data.

• Ability to work independently with minimal supervision.

• Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts.

• Proficient use of Microsoft Office, Word, Excel, and Access.

Physical Demands:

• Position requires manual and finger dexterity and hand-eye coordination.

• Involves standing, sitting, and walking.

• Team member will occasionally be asked to lift and carry items weighing up to 10 pounds.

Benefits and Perks:

• We offer an outstanding team-oriented environment, challenging and rewarding careers, and valuable benefits to our employees.

• Be a part of an experienced team: We are a family-oriented facility with many of our employees with us for 10, 20, or more years!

• Work in a highly-respected organization that is committed to quality patient care!

• Flexible scheduling that works around your school schedule.

• Competitive wages, superior pension, and retirement plan with employer contributions.

• Shift differential for working evening and night shifts.

• Excellent vacation, holiday, and sick leave package.

• Tuition assistance to provide opportunities for career growth.

• Independent health insurance, dental, vision, and no-cost life insurance.

• Free parking, safe, and quiet country setting in Medina along the historic Erie Canal!

• The satisfaction of knowing you’re making a difference in someone’s life every day.

For more information, please send your resume directly to elizabeth@ka-recruiting.com or call/text me at 617-746-2747 .

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