Credentialing Specialist (Temporary)
About The Position
The Credentialing Specialist performs credentialing for all Medical Staff and Advanced Practice Providers at GSSC. The role processes applications within a 30-day turnaround time or sooner when applicable, maintains accurate credentialing database information, and works with practitioners to complete applications in compliance with Medical Staff Bylaws and policies. The specialist reviews provider information against general criteria, documents deficiencies, communicates requests for clarification or additional compliance materials, and prepares verified files for leadership recommendations. The position also monitors expirables and ongoing credentialing activities, responds to facility affiliation requests, generates case logs upon request, and maintains communication with provider offices. The role adheres to organizational policies and procedures, including timely work completion and appropriate use of resources, and performs other duties and projects as assigned.
Requirements
- Minimum 2 years of experience in credentialing or a related field.
- Demonstrated proficiency in credentialing software.
- Maintain strict confidentiality of provider information and ensure privacy.
- Working knowledge of Microsoft Office, including Outlook, Word, and Excel.
- Maintain current knowledge of NCQA, state, and federal requirements.
- Perform data entry and maintain a current database for tracking practitioner credentialing and re-credentialing information.
- Self-starter with the ability to manage multiple priorities.
- Detail-oriented.
- Communicative.
- Problem-solving and analysis skills.
- Time-management and task-completion skills.
- Team player.
Nice To Haves
- Certification or training in a related area is strongly preferred.
Responsibilities
- Monitor the work queue to ensure applications are processed within a 30-day turnaround time or sooner, if applicable.
- Perform credentialing for Medical Staff and Advanced Practice Providers at GSSC.
- Maintain accurate and complete information in the credentialing database.
- Work with practitioners to ensure timely and thorough completion of applications in compliance with Medical Staff Bylaws and policies.
- Apply general guidelines to determine whether providers meet criteria and document deficiencies.
- Communicate with providers about items requiring clarification or additional compliance requirements.
- Assemble verified information and prepare files for presentation to appropriate leadership for recommendations.
- Maintain communications with provider offices to support the credentialing process.
- Monitor monthly expirables, including liability insurance, licenses, DEAs, Fluoro and other certificates, and immunization records.
- Monitor ongoing proctoring, OPPE, and Peer Review.
- Respond to affiliation requests from other facilities.
- Generate case logs upon request.
- Perform other duties and projects as assigned.
- Adhere to policies and procedures, including timely delivery of completed work and use of resources.
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What This Job Offers
Education Level
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