Credentialing Specialist (Temporary)
About The Position
The Credentialing Specialist performs credentialing for all Medical Staff and Advanced Practice Providers at GSSC. The role monitors applications and work queues to ensure processing 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 whether providers meet criteria, documents deficiencies, communicates clarification or compliance needs, verifies and assembles information, and prepares files for leadership recommendations. The role also monitors expiring credentials and documents, ongoing proctoring, OPPE, and Peer Review. It responds to affiliation requests, generates case logs upon request, maintains relationships with provider offices, and performs other assigned duties and projects. The position requires confidentiality, proficiency with credentialing software, current knowledge of NCQA and state and federal requirements, and effective management of multiple priorities.
Requirements
- Minimum 2 years of experience in credentialing or a related field.
- Demonstrated proficiency in credentialing software.
- Working knowledge of Microsoft Office, including Outlook, Word, and Excel.
- Maintain current knowledge of NCQA and state and federal requirements.
- 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 all Medical Staff and Advanced Practice Providers at GSSC.
- Maintain accurate and complete information in the credentialing database.
- Work with practitioners to support timely and thorough application completion in compliance with Medical Staff Bylaws and policies.
- Apply general guidelines to determine whether providers meet criteria and document deficiencies.
- Communicate items requiring clarification or additional compliance requirements to providers.
- Assemble verified information and prepare files for presentation to appropriate leadership for recommendations.
- Maintain communications with provider offices to promote relationships necessary for the 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.
- Perform data entry and maintain the current database for tracking practitioner credentialing and re-credentialing information.
- Adhere to policies and procedures, including timely delivery of completed work and use of resources.
- Maintain strict confidentiality of provider information and ensure privacy.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
