Credentialing Specialist (Chief Medical Administration)

FDIHB•Fort Defiance, AZ

2d•Onsite

About The Position

The Credentialing Specialist is responsible for ensuring the proper execution of the credentialing and privileging process for the Medical Staff. This includes managing requests for appointment, reappointment, expansion or reduction of privileges, temporary membership, and temporary privileges. The role also involves verifying current licensure and ensuring compliance with Centers for Medicare and Medicaid Services (CMS) requirements, FDIHB credentialing policies, and FDIHB Bylaws of the Medical Staff. The specialist will oversee background research on all applications, including verification of education, training, experience, references, state licenses, malpractice concerns (via NPDB), CME, and current competence through peer recommendations. They will also notify medical staff of expiring credentials, prepare and distribute Medical Executive Committee (MEC) lists, provide medical staffing reports, communicate with the Provider Enrollment Team and Medical Staff Recruiter, assist with Medical Staff Meetings, handle inquiries, maintain filing systems, prepare various documents, and manage correspondence related to medical staff credentialing.

Requirements

One (1) year of direct experience in credentialing and medical staff privileging
Or Three (3) years’ experience in a medical staff support role
Or One (1) year experience in payor/provider enrollment
Associate Degree or equivalent direct experience.
A valid, unrestricted insurable driver's license.
Resumes and references are required.

Responsibilities

Ensures the proper execution of the credentialing and privileging process for the Medical Staff, including requests for appointment, reappointment, expansion or reduction of privileges, temporary membership, temporary privileges, and verification of current licensure.
Ensures compliance with Centers for Medicare and Medicaid Services (CMS) requirements, FDIHB credentialing policies and FDIHB Bylaws of the Medical Staff.
Oversees and completes background research on all applications such as: Verification of education, training and experience. Obtaining reference from other hospitals and health professionals. Verification of state license(s) Verification of malpractice concerns via National Practitioner Data Bank (NPDB) and other sources. Verification of Continuing Medical Education (CME). Verification of current competence and professional conduct through peer recommendations.
Provides notification to medical staff of any expiring license, board certification, and Drug Enforcement Agency (DEA) number.
Prepares and distributes Medical Executive Committee (MEC) list for appointment, reappointment for permanent, temporary and consulting staff.
Provides general medical staffing reports as requested by the Chief Medical Officer and Chief of Staff.
Provide regular communication with the Provider Enrollment Team and Medical Staff Recruiter and other team members to ensure a timely provider onboarding.
Assist with coordination of Medical Staff Meetings.
Receives telephone calls and visitors; screens inquiries, takes care of routine matters, referring callers/visitors to appropriate personnel.
Establishes and maintains an efficient filing system for the credentialing documentation.
Prepares a variety of materials such as correspondence, reports, technical documents, requisitions, forms, meeting minutes and memos using automated systems.
Receives reviews and distributes incoming correspondence related to the medical staff credentialing.
Maintains control of correspondences and action documents to enable follow-up status and/or progress to ensure timely action in accordance with established requirements and deadlines.
Other duties as assigned.