CREDENTIALING SPECIALIST

Covenant HealthCare•Saginaw, MI

About The Position

The Credentialing Specialist I in the Medical Staff office coordinates the full lifecycle of health professional credentialing and re-credentialing for initial appointments, reappointments, and locum tenens coverage. The role validates the credentials, qualifications, competency, education, training, and experience of Covenant Healthcare professionals and ensures that providers meet standards for quality and competency before providing patient care. The position supports compliance with applicable healthcare laws, accreditation requirements, Medical Staff Bylaws, and credentialing policies. It maintains credentialing records and databases, communicates with applicants and leadership about credentialing status and timelines, and collaborates with internal teams and external organizations. The role also supports meetings, reporting, dues and fee collection, and other Medical Staff office activities. It is expected to demonstrate customer service consistent with Covenant Healthcare’s Vision, Mission, Values, and commitment to Extraordinary Care for Every Generation.

Requirements

Associate’s degree in Health Services Administration or Business; alternatively, a high school diploma with two years of advanced administrative assistant experience or relevant credentialing, physician office, healthcare or hospital, health plan, or payor enrollment experience.
Fundamental knowledge of credentialing processes and healthcare compliance.
Ability to recognize and question responses to queries and competency requests in accordance with evidence-based practice, Medical Staff Bylaws, and credentialing policies and procedures.
Superior organizational skills to meet credentialing and privileging timelines.
Strong attention to detail and ability to capture health professional and other data accurately.
Strong interpersonal, listening, writing, and speaking skills.
Excellent written communication skills for minutes and correspondence, and strong verbal communication skills for individual and group settings.
Excellent typing, word-processing, and computer skills, including Microsoft Office.
Ability to balance multiple priorities and meet deadlines.
Self-directed and able to work with minimal supervision.
Ability to maintain confidentiality and protect credentialing materials, meetings, and conversations.
Ability to maintain regular, punctual attendance consistent with applicable standards.
Constant hearing, near vision, and midrange vision.
Frequent lifting up to 10 pounds.
Frequent standing, walking, sitting, far vision, depth perception, visual accommodation, color vision, and field of vision.
Occasional lifting, carrying, pushing, pulling, twisting, reaching, handling, feeling, and talking.

Nice To Haves

Experience in medical staff services, graduate medical education, healthcare compliance, physician or hospital settings, or insurance credentialing, health plan, or payor enrollment.
Basic knowledge of medical terminology.
Experience with MD Staff or other electronic credentialing software.

Responsibilities

Respond to appointment and reappointment requests by sending applications and clinical privileges or service authority forms through the MD Staff Software system.
Review initial and reappointment applications for eligibility, completeness, and supporting documentation; return incomplete applications.
Coordinate initial and reappointment credentialing and privileging for physicians, advanced practitioners, and non-physician practitioners.
Obtain primary-source verification of credentials, including licenses, education, affiliations, references, background checks, federal sanctions, and relevant national databases and organizations.
Maintain accurate credentialing and privileging files and confirm that health professionals are cleared and board approved before providing patient care.
Review requested privileges against providers’ education, training, and experience and recommend whether they are qualified to provide safe, competent care.
Obtain privileging documentation and clinical activity needed to establish and maintain competency requirements under ACHC standards and state and federal regulations.
Perform final application analysis and determine when credentialing files are complete and ready for committee and board review, consulting the Manager or Credentialing Specialist II as needed.
Identify and assess red flags in the credentialing and privileging process, attempting local resolution or consulting the Manager about escalation.
Prepare appointment and reappointment summaries for Section Chief and Department Chair review in accordance with Medical Staff Bylaws and credentialing policies.
Prepare applications for MD Staff Virtual Committee review and recommendation.
Schedule and attend meetings; perform data entry, data integrity, record management, and other administrative tasks.
Maintain professional knowledge and skills by participating in professional organizations, seminars, and relevant publications.
Process resignations, archive files, update MD Staff, and add matters to the Credentials Committee agenda.
Process changes of status and additional privilege requests in accordance with evidence-based practice, TJC standards, and state and federal guidelines.
Assist with Mackinaw Surgery Center reappointments under the direction of the Credentialing Specialist II.
Assist with onboarding and training new Credentialing Specialist I staff as directed.
Coordinate annual Medical Staff dues collection, including invoicing, payment collection, journal entries, follow-up, payment logging, and deposits.
Assist the Medical Staff Manager with biannual Medical Staff elections.
Collect application fees, log payments in MD Staff, and prepare and perform deposits.
Stay current with federal, state, and accreditation requirements, including CMS and ACHC requirements.
Track license, certification, and accreditation expiration dates and communicate regularly with health professionals to prevent lapses.
Safeguard provider and facility compliance with healthcare laws and standards and apply Medical Staff Bylaws and credentialing processes uniformly.
Maintain current credentialing and privileging databases and file systems while ensuring confidentiality and compliance with HIPAA and other privacy regulations.
Assist with running and creating reports for leadership and regulatory agencies as requested.
Collaborate with HR, physician recruiters and liaisons, Payor Enrollment, PHO, and leadership to keep credentialing processes on track.
Provide applicants and leadership with updates and proactive recommendations about credentialing status and timelines.
Respond to inquiries from health professionals, accreditation organizations, external vendors, and leadership about credentialing and privileging.
Participate in the Michigan Association of Medical Staff Services to network and advance skills through education and collaboration.
Perform other duties as assigned.