Credentialing Specialist-ARMC(Day)FT

Adena Health•Chillicothe, OH

2d•Hybrid

About The Position

A Credentialing Specialist makes sure healthcare providers meet the necessary qualifications to provide care. The primary responsibility is to verify and assess the credentials of providers to ensure compliance with industry standards and regulatory requirements. This includes reviewing applications, verifying their qualifications such as education, licensure status, certifications, or other credentials by directly contacting institutions, licensing boards and previous employers to validate the information provided is accurate and up-to-date. They conduct thorough background checks to identify any potential risks or red flags that may impact patient safety. The Credentialing Specialist reviews privileges requested by the healthcare provider, compares to their education and training, contrasted with relevant experience to recommend if the individual is qualified to provide safe and competent patient care. The Credentialing Specialist ensures healthcare providers maintain their credentials by monitoring expiration dates of licenses and certifications. They may facilitate the process of updating credentials as required to ensure the caregiver and facilities remain compliant with all certification and accreditation requirements. They also serve as a point of contact for credentialing related inquiries and assists in the preparation of necessary reports. In addition to being responsible for updating and maintaining credentialing databases, scheduling and attending meetings, data entry/integrity, record management and performing other administrative tasks as assigned. This individual plays a key role in maintaining the integrity of healthcare delivery and protecting patient well-being. Following an orientation period, with appropriate knowledge in hospital medical staff credentialing; employees, at the discretion of their supervisor, may have an opportunity for a schedule to include a remote/work from home. If approved to work from home, individual must hold a dedicated workspace free from distractions with reliable internet access and a strong understanding of company policies.

Requirements

Bachelor's degree in a health-related field or equivalent experience
De-escalation training within 6 months
Must possess a valid National Association Medical Staff Services (NAMSS) Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS); within two years from the date of hire and when meeting the eligibility criteria
Experience in medical credentialing, health care administration, or related field

Nice To Haves

1-2 years experience

Responsibilities

Verify and assess the credentials of providers to ensure compliance with industry standards and regulatory requirements
Review applications
Verify qualifications such as education, licensure status, certifications, or other credentials
Contact institutions, licensing boards and previous employers to validate the information provided is accurate and up-to-date
Conduct thorough background checks to identify any potential risks or red flags that may impact patient safety
Review privileges requested by the healthcare provider, compares to their education and training, contrasted with relevant experience to recommend if the individual is qualified to provide safe and competent patient care
Ensure healthcare providers maintain their credentials by monitoring expiration dates of licenses and certifications
Facilitate the process of updating credentials as required to ensure the caregiver and facilities remain compliant with all certification and accreditation requirements
Serve as a point of contact for credentialing related inquiries and assists in the preparation of necessary reports
Update and maintain credentialing databases
Scheduling and attending meetings
Data entry/integrity
Record management
Performing other administrative tasks as assigned