Credentialing Specialist

Presbyterian Healthcare Services • Albuquerque, NM

47d • $27 • Onsite

About The Position

Presbyterian is seeking a highly detail-oriented Credentialing Specialist to conduct comprehensive background investigations on physicians and healthcare providers seeking affiliation with our Albuquerque and regional facilities. This is a Full Time position - Exempt: No Job is based at Presbyterian Hospital Work hours: Days Ideal Candidate: Experience in hospital medical staff or manager care credentialing preferred.

Requirements

• High School Diploma.
• One (1) to three (3) years experience in hospital medical staff or managed care credentialing preferred.
• Certification or eligibility for certification as a Current certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.
• Education Essential: High School Diploma or GED

Nice To Haves

• Experience in hospital medical staff or manager care credentialing preferred.
• Certification or eligibility for certification as a Current certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.

Responsibilities

• Analyze practitioner applications and/or requests to ensure that required documentation/information has been submitted in order to initiate the primary source verification processes
• Conducts primary source verification of applicants' education, licensure, professional work history, medical malpractice history for the purpose of determining competency and eligibility to be awarded membership and/or privileges
• Prepares processed files for review by appropriate members of medical staff leadership, including identification of information that may require additional investigation
• Utilizes appropriate tracking tools for the purpose of ensuring timely completion of applications
• Collects/analyzes data from various sources to include with initial and/or reappointment applications. Such data includes but is not limited to focused professional practice evaluations, ongoing professional practice evaluations, and privileging eligibility criteria
• Process other credentialing requests, as assigned, in accordance with established policies and procedures
• Responsible for on-boarding and/or orientation of new Medical Staff members, according to established policies and procedures

Benefits

• Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.
• The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.
• As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.
• Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group.
• With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees