Credentialing Specialist Casual - Remote

Adena Health System

126d • Remote

About The Position

A Credentialing Specialist makes sure healthcare providers meet the necessary qualifications to provide care. The primary responsibility is to verify and assess the credentials of providers to ensure compliance with industry standards and regulatory requirements. This includes reviewing applications, verifying their qualifications such as education, licensure status, certifications, or other credentials by directly contacting institutions, licensing boards and previous employers to validate the information provided is accurate and up-to-date. They conduct thorough background checks to identify any potential risks or red flags that may impact patient safety. The Credentialing Specialist reviews privileges requested by the healthcare provider, compares to their education and training, contrasted with relevant experience to recommend if the individual is qualified to provide safe and competent patient care. The Credentialing Specialist ensures healthcare providers maintain their credentials by monitoring expiration dates of licenses and certifications. They may facilitate the process of updating credentials as required to ensure the caregiver and facilities remain compliant with all certification and accreditation requirements. They also serve as a point of contact for credentialing related inquiries and assists in the preparation of necessary reports. In addition to being responsible for updating and maintaining credentialing databases, scheduling and attending meetings, data entry/integrity, record management and performing other administrative tasks as assigned. This individual plays a key role in maintaining the integrity of healthcare delivery and protecting patient well-being.

Requirements

• Bachelor's degree in a health-related field or equivalent experience.
• Must possess a valid National Association Medical Staff Services (NAMSS) Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) within two years from the date of hire and when meeting the eligibility criteria.
• Experience in medical credentialing, health care administration, or related field.

Responsibilities

• Verify and assess the credentials of healthcare providers.
• Review applications and verify qualifications such as education, licensure status, and certifications.
• Conduct thorough background checks to identify potential risks or red flags.
• Review privileges requested by healthcare providers and compare them to their education and training.
• Monitor expiration dates of licenses and certifications to ensure compliance.
• Facilitate the process of updating credentials as required.
• Serve as a point of contact for credentialing related inquiries.
• Assist in the preparation of necessary reports.
• Update and maintain credentialing databases.
• Schedule and attend meetings, perform data entry/integrity, and manage records.

What This Job Offers

• Industry: Educational Services
• Education Level: Bachelor's degree