Credentialing Specialist, Sr.

Orlando Health•Orlando, FL

10d•Hybrid

About The Position

The Credentialing Senior Specialist provides support and acts as liaison to 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.

Requirements

High school graduate or equivalent.
Knowledge of medical terminology.
Four (4) years of experience credentialing/privileging.
Experience with credentialing/privileging and working with Joint Commission and/or NCQA standards.
Experience in completion of meeting minutes.
Proficiency in Microsoft Word, Excel, Internet and significant proficiency in credentialing data system skills necessary to maintain credentialing, meeting support activities, and reporting abilities relative to physician and advanced practice professional activity and statistics.

Nice To Haves

Associate degree in business, health care, accounting or related field may be substituted for two years of experience.

Responsibilities

Completion of initial and reappointment applications for physicians, assuring compliance with regulatory and accreditation standards, as well as the Orlando Health Bylaws, Policies and Procedures, Rules & Regulations.
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 supervisor.
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.
Communicates with Medical Staff Liaisons during the credentialing process.
Preparation and accuracy of credentialing reports at least one week prior to dues date for submission to Management.
Researches incidents, submission of applications for timely processing, and request appropriate follow-up information as needed.
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 and training.
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.
Interacts on a daily basis with medical staff leadership, department chairs, administration medical staff services team and executive staff.
Provides exceptional customer service to all internal and external customers, including physicians, advanced practice professionals their office staff, other departments, and within the Medical Staff Services team.
Assists Medical Staff Supervisor with preparation for Credentials Committee and credentialing report to Medical Executive Committee and Board of Directors.
Interacts with and provides support to department chairmen and leadership chairmen in the preparation of credentials files and Clinical Privilege Descriptions.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
Maintains compliance with all Orlando Health policies and procedures.
Assists physicians and others with all matters relative to Medical Staff membership and clinical privileges.
Develops and maintains a working knowledge of statutes and laws as relates to credentialing/privileging.
Maintains confidentiality.
Assumes responsibility for professional growth and development.