OverviewThe Senior Credentialing Specialist contributes to the ongoing achievement of the organization's goals through ensuring providers are credentialed using vetted processes and procedures.
Identifies, analyzes, and resolves information, discrepancies, and time gaps that could adversely affect a facility's ability to credential and privilege providers.
Partners with medical staff, credentialing and privileging committees, and other key stakeholders to ensure compliance with credentialing standards.
Responsible for maintaining accurate and comprehensive data in the credentialing software.The Senior Credentialing Specialist must have overall knowledge of the credentialing and privileging process, know the required credentials for health care professionals and can utilize the appropriate resources to complete Prime Source Verification (PSV) and databank queries.
Senior Credentialing Specialists demonstrate a thorough knowledge on credentialing policies, guidelines, and regulations for the CVO credentialing process.Duties & ResponsibilitiesHandles and oversees the processing of provider applications and re-applicationsMaintains accurate provider profiling system dataCommunicates with providers concerning credentialing statusResponds to requests for provider informationEnforces regulatory compliance and quality assuranceSupport, in conjunction with the QA Team, any adverse action activities in accordance with regulations and policiesPrepare documentation, conduct, and conclude credentialing and privilegingWork, in conjunction with leadership, to identify potential 'pitfalls' in the CVO credentialing processMeet productivity standards as outlined in CVO and client metricsSkills RequiredStrong interpersonal
skills-works well with a teamStrong oral and written communication skillsStrong conflict resolution skillsExceptional attention to detailExceptional analytical skillsCustomer interaction experienceQualifications Required:Bachelor's Degree and/or equivalent work experience3 plus years of experience in medical credentialingStrong knowledge of industry standards, to include but not limited to: TJC, NCQA, AAAHC and DNV Strong knowledge of the Microsoft office suite to include Excel Affinity to multi-taskCertification Preferred: CPCSMinUSD $24.00/Hr.MaxUSD $28.00/Hr.Originally posted on Himalayas
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