The Credentialing Specialist for Healthcare is responsible for supporting and conducting activities to ensure quality in conducting, maintaining, and communicating clinician credentialing, privileging, and source verification. The Credentialing Specialist assists in pre-boarding healthcare employees and working collaboratively with leaders in the healthcare centers to ensure that the clinical team is appropriately privileged.

Job Qualifications

• Demonstrated experience with verifying the credentials of healthcare providers
• High school diploma or equivalent required
• Demonstrated experience gathering and inputting information
• Intermediate use of Excel and Outlook and demonstrated experience in self-directed learning and troubleshooting software

Essential Job Duties & Responsibilities

• Serve as a liaison between organization, practitioners, and the credentialing service to ensure compliance with HRSA, Joint Commission and CARF requirements and ensure provider enrollment.
• Ensure that provider credentialing documentation is collected prior to the provider start date of employment and maintained throughout the provider’s tenure with The Centers. Assists clinicians in completing applications and other data entry with the outsourced credentialing service.
• Monitor the Outsourced Credentialing Service’s information systems in order to take proactive steps in resolving discrepancies with providers.
• Alert the HR Business Partner and the Chief Medical Officer when adverse actions are taken against a provider; prepares communication to the provider.
• Compile, evaluate, and present the provider specific data collected for review by one or more decision-making bodies.
• Work to resolve issues and concerns between the outsourced credentialing service and The Centers clinical team; escalate concerns to Director, Revenue Operations, Planning and Analysis, HR Business Partner, Finance, and Clinical leadership as appropriate.
• Work collaboratively with Compliance to ensure that rosters are up to date for peer review, insurance enrollment and oversight organizations.
• Notify Compliance of any adverse licensing issues.
• Support and actively participate in the set-up, implementation and ongoing maintenance of an in-house credentialing system.

Other Job Duties & Responsibilities

• Other related duties as assigned.

Core Competencies

• Credentialing Software Proficiency: Familiarity with credentialing software like CAQH ProView and Cactus Software is essential for managing and verifying healthcare provider credentials efficiently.
• Regulatory Compliance: Understanding and adhering to standards set by organizations such as the Joint Commission (JCAHO) and the National Committee for Quality Assurance (NCQA) is critical.
• Primary Source Verification: This involves verifying the authenticity of credentials directly from the issuing institutions.
• Data Management: Strong skills in data entry and database management to maintain accurate and up-to-date records
• Customer Service: Excellent customer service skills to interact effectively with healthcare providers and other stakeholders.
• Attention to Detail: Ensuring all credentials and documentation are accurate and complete to avoid compliance issues.
• Communication Skills: Clear and effective communication, both written and verbal, to coordinate with various departments and external entities.

Physical Demands/Work Environment

• Sitting: The job requires sitting for extended periods while working on a computer
• Manual Dexterity: Frequent use of hands and fingers to operate office equipment, such as computers, phones, and other tools
• Visual Acuity: Goodvision is necessary for reading and analyzing documents and data.
• Communication: Effective verbal and written communication skills are essential.

This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of The Centers. Since no position description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder’s responsibility.
Supervisory
This position does not supervise any position.
The Centers is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law

Essential Job Duties & Responsibilities

• Serve as a liaison between organization, practitioners, and the credentialing service to ensure compliance with HRSA, Joint Commission and CARF requirements and ensure provider enrollment.
• Ensure that provider credentialing documentation is collected prior to the provider start date of employment and maintained throughout the provider’s tenure with The Centers. Assists clinicians in completing applications and other data entry with the outsourced credentialing service.
• Monitor the Outsourced Credentialing Service’s information systems in order to take proactive steps in resolving discrepancies with providers.
• Alert the HR Business Partner and the Chief Medical Officer when adverse actions are taken against a provider; prepares communication to the provider.
• Compile, evaluate, and present the provider specific data collected for review by one or more decision-making bodies.
• Work to resolve issues and concerns between the outsourced credentialing service and The Centers clinical team; escalate concerns to Director, Revenue Operations, Planning and Analysis, HR Business Partner, Finance, and Clinical leadership as appropriate.
• Work collaboratively with Compliance to ensure that rosters are up to date for peer review, insurance enrollment and oversight organizations.
• Notify Compliance of any adverse licensing issues.
• Support and actively participate in the set-up, implementation and ongoing maintenance of an in-house credentialing system