Medical Staff Credentialing Specialist

RWJBarnabas Health•Somerset, NJ

43d•Hybrid

About The Position

The Credentialing Specialist is accountable for performing duties related to the sending, receiving, processing, and primary source verifying applications for initial and reappointment and their related clinical privileges. Exemplifies a culture of excellence, effective communication and collaboration, and customer service with central Medical Staff Office (MSO) leadership and staff, internal and external customers, providers, and clinical and administrative leaders within RWJBarnabas Health. Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential. Possesses and develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to collaborates with local Medical Staff Offices to facilitate timely completion of credentialing processing. Works to develop an overall singular culture of excellence and efficiency across the enterprise.

Requirements

Associates degree or combination of education and experience deemed equivalent
Successful completion of all RWJBarnabas Health orientation programs
Excellent interpersonal and communication skills

Nice To Haves

Two years' prior experience in Medical Staff credentialing preferred.
Certified Professional in Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred
Knowledge of credentialing software and associated applications strongly preferred (MDStaff)

Responsibilities

Oversees and assists with application management and verification activities, preliminary analysis of application and verification information
Analyze verification information, to include identifying red flag and/or adverse information and notifying central MSO leadership in accordance with policies
Oversee the monitoring of expiring information such as but not limited to DEA, license, professional liability insurance, and specialty board certification status; maintain and update credentials file(s)
Management of database entries for accuracy and completeness
Maintenance of electronic files as required
Effective and timely communication with local medical staff offices
Timely and accurately prepare credential files for audit and submission to the hospitals
Monitor staff productivity in accordance with standard turn-around-times
Maintain a working knowledge of relevant regulatory standards (i.e., TJC, DNV and NCQA), state and federal requirements, and applicable Medical Staff Bylaws
Assist with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes
Assist in the development or revision of credentialing related forms
Participation in special project teams as assigned
Training of new staff as assigned - credentialing procedures, software, and workflows
Enforcement of internal procedures and controls and problem resolution
Takes a proactive role in monitoring and assisting in improving team productivity
Continually strives to achieve individual, team and departmental goals
All other duties as assigned