Credentialing Specialist - Hybrid (Full Time, Day shift)

Nicklaus Children's•Miami, FL

1d•Hybrid

About The Position

The NCPS Credentialing & Onboarding Specialist is an integral member of NCPS, partnering with Medical Staff Offices (MSOs), practice operations, and TM&E to support provider onboarding, credentialing, recredentialing, and privileging-related activities. This role provides exceptional customer service to physicians, advanced practice providers, other clinicians, and internal and external stakeholders by coordinating the efficient and accurate processing of credentialing applications and related files for affiliate hospitals, internal telehealth credentialing, and all applicable service locations. The NCPS Credentialing & Onboarding Specialist plays a critical role in collecting, reviewing, tracking, and vetting provider applications and supporting documentation to ensure compliance with applicable organizational, regulatory, accreditation, and affiliate requirements. The role also coordinates onboarding activities for physicians and other NCPS providers to support timely onboarding, orientation readiness, and start-date preparedness. In addition, this position helps ensure that all NCPS providers are appropriately credentialed and recredentialed at all applicable locations where services are rendered. For purposes of this role, providers include physicians and other NCPS providers.

Requirements

1-3 years of healthcare credentialing, provider onboarding, medical staff services, or related healthcare operations experience.
Highly organized in managing schedules, duties, workflows, and responsibilities.
Ability to effectively organize and prioritize work.
Willingness to take direction and apply learning to all relevant tasks.
Strong verbal and written communication skills.
Strong attention to detail.
Exceptional customer service skills.
Ability to communicate diplomatically within a multi-functional team.
Ability to work in a fast-paced environment meeting multiple deadlines.
Excellent problem-solving ability in a broad range of areas to address all the potential problems that may arise (scheduling conflicts, communication or technical problems, etc.)
Ability to effectively communicate complex technology concepts to diverse audiences.
Strong ability to learn new software and processes.
Continual process improvement mindset.

Nice To Haves

Bachelor's degree in Health Administration, Business, or related degree preferred.
National Association Medical Staff Services (NAMSS) Certification preferred.
Experience in provider credentialing and software preferred (i.e. Cactus or Parallon)

Responsibilities

Coordinates and manages the credentialing process for new and existing NCPS clinicians, within the system and external affiliations. This includes communicating with the provider, obtaining new and/or updated data necessary for the completion of applications, and submitting applications to credentialing bodies.
Includes credentialing and recredentialing support for all NCPS providers at all applicable practice, hospital, telehealth, and affiliate locations.
Prepopulates clinician new and re-credentialing applications accurately as needed.
Collects and verifies information, including licenses, certifications, and professional references.
Supports provider onboarding by collecting, organizing, and tracking required documentation needed for timely activation and start-date readiness.
Promptly and accurately reviews provider applications to ensure compliance with internal and external affiliate hospital standards, regulatory requirements, and other applicable requirements.
Responsible for maintaining accurate and up-to-date records in electronic credentialing databases and other systems.
Verifies and maintains provider information and ensures that all provider information, including licensure, education, training, and certification, is accurate.
Monitors and tracks expiring credentials at other affiliate hospitals to ensure timely renewals. This involves notifying providers of upcoming expiration of privileges and following up to ensure that renewals are completed.
Processes credentialing fees as applicable.
Collaborates with internal and external stakeholders and MSOs at affiliate organizations to provide required credentialing information and supporting documents.
Maintains open communication with the credentialing teams and all stakeholders throughout the credentialing process.
Communicates with providers and hospitals to resolve any credentialing issues or discrepancies.
Completes assigned work within specified timelines, ensures timely completion of credentialing tasks, proactively communicates progress and issues to relevant parties.
Holds self-accountable for understanding and resolving problems, issues, and provides options for resolutions.
Delivers high-quality outputs consistent with expectations, maintains accurate and up-to-date credentialing files and provides regular updates to leadership.
Develops and maintains relationships with key stakeholders and works closely with healthcare providers and external organizations to facilitate the credentialing process. This may involve developing and maintaining relationships with providers, affiliate organizations, Medical Staff Offices, hospitals, and regulatory bodies.
Provides support and guidance to providers and internal stakeholders on matters related to credentialing and privileging. This may involve answering questions, providing training, and addressing concerns or issues related to the credentialing process.
Participates in quality improvement activities related to credentialing and privileging processes. This may involve analyzing data and identifying areas for improvement, as well as developing and implementing process improvements.
Coordinates physician onboarding responsibilities from pre-start through onboarding, including intake, document collection, tracking onboarding milestones, coordinating orientation readiness, and communicating with internal stakeholders to support timely provider activation.
Ensures all NCPS providers are credentialed, recredentialed, and, as applicable, privileged at all applicable locations where services are rendered, in accordance with organizational, affiliate, facility, regulatory, and accreditation requirements.
Partners with practice leadership, operations, TM&E, Medical Staff Offices, and affiliate location contacts to resolve onboarding and credentialing issues that may affect provider readiness across locations.
Supports provider onboarding and MSO and Telehealth credentialing readiness activities for physicians and other NCPS providers; payer enrollment functions are excluded from this role unless specifically assigned.