Credentialing Specialist — Clinical Operations

Bon Secours Mercy Health

2d • Onsite

About The Position

The Credentialing Specialist facilitates Credentials Verification Organization (CVO) provider application and data collection, application processing and Primary Source Verification (PSV) for the organization. Supports the organization's on-boarding and off boarding processes. This role follows established standard operating procedures and market specific medical staff bylaws and demonstrates exceptional customer service, communication, reliability and commitment to quality.

Requirements

• High School or GED (required)
• 1 year recent experience in medical staff services or CVO setting (preferred)

Nice To Haves

• Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services (NAMSS) (preferred)
• Bachelor's Degree in Business, Healthcare or other related field (preferred)
• Master's Degree in Business, Healthcare or other related field (preferred)
• CredentialStream Credentialing software (STRONGLY preferred)

Responsibilities

• Follows a standardized comprehensive credentialing application and data collection, application processing, and primary source verification processes that comply with all applicable regulatory standards.
• Executes credentialing application and data collection, application processing, primary source verification for all new applicants and applicants for re-credentialing.
• Assures applications are correct, complete, resolves discrepancies in compliance with all applicable regulatory standards.
• Assures files and documents are ready for Medical Director review, including all Credential Committees and Medical Staff Office (MSO).
• Works with the credentialing auditors to correct any deficiencies.
• Organizes and maintains provider data and files.
• Processes applications timely and ensures that quality benchmarks are met with regards to turnaround times, accuracy of information and other CVO and regulatory metrics.
• Assures that provider database is maintained with new and updated accurate provider information.
• Follows all regulatory requirements related to the primary source verification process for medical staff and managed care compliance.
• Completes credentialing compliance check points to assure that files are ready for release.
• Maintains awareness of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Center for Medicare/Medicaid (CMS) and other regulatory compliance guidelines through the organization's CVO provided continuing education.
• Demonstrates excellent professional communication skills while interacting with colleagues, customer relations and MSO representatives, and leadership to collect missing information or resolve issues.
• Maintains a strong respect for privacy and confidentiality.

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED