Credentialing Specialist

Appalachian Regional Healthcare, Inc.•Lexington, KY

About The Position

The Credentialing Specialist performs the organization’s credentialing, re-credentialing, and privileging processes. The position reports directly to the System Director of Medical Affairs and Provider Enrollment. The specialist processes and maintains credentialing files, verifies required information through primary sources, and coordinates completed files for recommendation and approval through the Medical Staff process. The role also supports system-wide process improvements, communicates with providers and organizational stakeholders, maintains provider information in online systems, and protects the confidentiality of provider information.

Requirements

High school diploma required.
Knowledge and understanding of the credentialing process.
Ability to organize and prioritize work and manage multiple priorities.
Excellent verbal and written communication skills, including writing letters, memos, and emails.
Excellent attention to detail.
Ability to research and analyze data.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts.
Proficiency with Microsoft Office applications, including Word and Excel, and internet resources.

Nice To Haves

Associate degree preferred.
Two years of relevant credentialing experience preferred.
Certified Provider Credentialing Specialist (CPCS) certification preferred, but not required.

Responsibilities

Process and maintain credentialing files.
Complete routine and assigned credentialing tasks accurately and on time.
Process pre-applications and prepare application packets for providers to complete.
Review and screen initial and reappointment applications for completeness, accuracy, and compliance with organizational guidelines, regulations, policies, and standards.
Identify, analyze, and resolve extraordinary information, discrepancies, time gaps, and other issues that could affect practitioners’ ability to be credentialed.
Communicate problems to Medical Affairs to support sound decision-making consistent with Medical Staff Bylaws and credentialing policies and procedures.
Participate in developing and implementing improvements to the system-wide credentialing process.
Communicate with providers, provider liaisons, Medical Affairs, Medical Staff leadership, and administration about credentialing and privileging issues.
Set up and maintain provider information in online credentialing databases and systems.
Maintain professional growth through seminars, workshops, and professional affiliations to stay current with regulations, legislation, and industry best practices.
Perform primary source verification for all required credentialing-file elements.
Coordinate with the Medical Staff Office to submit completed files for recommendation and approval through the Medical Staff process.
Maintain confidentiality of provider information.
Perform miscellaneous job-related duties as assigned.