Credentialing Specialist II - Medical Staff Services - Days - FT

Memorial Hospital at Gulfport•Gulfport, MS

16h

About The Position

The Memorial Credentialing Specialist II conducts and maintains physician credentialing, privileging, and primary source verifications for initial appointments and reappointments to the medical staff. The specialist maintains credentialing data and information systems to facilitate department processes and ensures standards and regulatory requirements are upheld to support organizational compliance.

Requirements

High school diploma or GED.
Certified Provider Credentialing Specialist (CPCS) certification.
Two years of credentialing experience in a hospital medical staff services setting.
Basic Microsoft Excel skills.
Strong verbal and written communication skills.
Accurate data entry with minimal errors.
Ability to seek solutions using appropriate methodologies.

Responsibilities

Coordinate credentialing and privileging processes for providers.
Assess applicants’ initial eligibility for medical staff membership or participation.
Compile and distribute required provider documentation to decision-making bodies for review.
Analyze applications and supporting documents for accuracy, completeness, and integrity.
Process requests for privileges.
Coordinate provider onboarding procedures.
Conduct and maintain primary source verification.
Support Medical Staff Services department meetings and special projects.
Maintain the credentialing database and ensure provider information is accurate and current.
Maintain practitioner/provider credentialing processes and information systems by analyzing the needs and resources of Medical Staff Services and credentialing.
Coordinate and prepare agendas and minutes for Medical Staff specialty department meetings.
Help maintain compliance with accreditation standards and regulatory requirements.
Facilitate efficient and cost-effective due process in compliance with the organization’s fair hearing and appeals policy and applicable legal and regulatory requirements.
Identify and report adverse actions taken against providers in accordance with applicable law and contractual requirements.
Monitor and report provider sanctions and complaints and recommend action by medical staff and organizational leadership.