Credentialing Specialist - Medical Staff Affairs - Days

Business (Non-Clinical)

Responsible for coordination and oversight of the hospital Medical Staff Affairs office, including collaborative participation with the Central Verification Organization (CVO) on the medical staff credentialing and recredentialing processes. Coordinates and manages medical staff meetings and the flow of the information from the Medical Staff Committees through the Medical Executive Committee to the Board of Trustees. Responds to verification requests. Acts as a resource to the medical staff regarding bylaws, rules and regulations, policies, regulatory and accreditation requirements and standards. Assists in compliance with the accrediting and regulatory agencies (i.e., Joint Commission, NCQA, URAC, HFAP) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws. Coordinates annual projects relative to the medical staff and performs bookkeeping activities for the medical staff. Work closely with and maintain close communications with physician quality, medical staff leaders, hospital administration, and legal counsel on selected medical staff issues. Maintains the confidentiality of all business / work and medical staff information. Functions as a member of the team to assure optimum performance of the department.

Principal Duties and Responsibilities :

Interprets, explains and follows all regulatory guidelines, including medical staff bylaws, rules and regulations and policies.

Credentialing initial and reappointment applications to meet regulatory and department standards and deadlines.

Education / Experience Required :

High School Diploma required. Associate's Degree, preferred. One (1) year of credentialing, provider enrollment, or background / verification specialist experience required. High level of energy to work in a fast paced environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking. Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and all applicable standards.