Job Summary The Credentialing Senior Specialist provides administrative support and acts as liaison to committees, physicians and other medical staff department members ensuring all medical staff credentialing is acted upon in a consistent and timely manner. May oversee other Credentialing Specialists.
Coordinates the timely processing of all activities of initial and reappointment applications for completeness and in accordance with appropriate standards relative to the organizations Credentialing Manual. Provides credentialing support to the credentialing manager and supervisory support to the credentialing specialists. Maintains a sound working knowledge of credentialing and provides consultation to the Network regarding credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies as demonstrated by observation.
Communicates with Medical Staff Coordinators during the credentialing process to ensure timely and expeditious completion of process.
Oversees preparation and accuracy of credentialing reports at least one week prior to dues date for submission.
Researches incidents, submission of applications for timely processing, and request appropriate follow-up information from Medical Staff Coordinators or other sources as indicated.
May be responsible to gather information and perform research in credentialing disputes under the direction of the Management.
Protects confidential information for peer review by the authorized personnel.
Secures appropriate peer competency references and prepares credentials files. Obtains primary source and other verifications in accordance with established guidelines. Communicates with applicants during credentialing process to ensure timely and expeditious completion of process. Researches incidents, malpractice claims, advisory letters/letters of concern etc and request appropriate follow-up information from practitioner or other sources as indicated.
Initiates and participates in cross-training and cross-coverage of credentialing departmental functions. Serves as departmental resource to employees. Mentors and assists other Credentialing Specialists in all aspects of credentialing functions.
Maintains the credentialing database. Ensures data is accurately entered as evidenced by audit. Prepares reports in compliance with requests for information as demonstrated by documentation.
Participates in departmental PI initiatives, including regulatory preparedness.
Coordinates and completes special projects in a timely manner. Appropriately prioritizes all tasks so that deadlines are met with continued focus on quality. Keeps staff apprised of any critical or major situations.
Drafts and assists in writing and reviewing policies and procedures and department rules and regulations. Ensures these do not conflict with medical staff by-laws and hospital policies and procedures/protocols.
Performs other duties as assigned.
Internal Number: 2018-11427
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We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.