Credentialing Specialist

CentraCare•Saint Cloud, MN

3d•$23 - $34•Hybrid

About The Position

Find your purpose as a Credentialing Specialist with CentraCare. As a Credentialing Specialist you are responsible for preparing files for medical staff credentialing and privileging for CentraCare within the Clinical Partner Resource Office. The Credentialing Specialist plays a significant key role in assuring physicians and advanced practice providers are qualified to provide quality patient care within CentraCare. The position must accurately and efficiently completes medical staff credentialing, privileging and recredentialing processes in compliance with regulatory requirements, often under short timelines and shifting organizational priorities. In collaboration with physician and advanced practice provider reviewers, incumbent will follow-up on red flag issues in files. Presents files at system-wide Credentialing Committee for discussion and review. Must be highly detail oriented to complete accurate data entry of demographics, education, training, prior hospital affiliations and employment verifications into the credentialing database. Communicate with the practitioners and hospital staff by phone, fax, or email to facilitate the completion or clarification of credentialing and privileging documents. Engages in activities to develop and improve documents, policies and procedures to support day-to-day operations. This role ensures compliance with the Joint Commission, NCQA, Centers for Medicare/Medicaid Services, and other laws or Hospital policies. Partners with the Supervisor of Credentialing, Recruitment, Contracting, Department and Medical Staff Leadership, St. Cloud Hospital Vice President of Medical Affairs, Credentials Committee members, members of the Medical Staff, Advanced Practice Providers, and the Medical Staff Office.

Requirements

Associate Degree or minimum of 3 years equivalent experience required in lieu of education.
2 years hospital and/or Health Care related experience required.
Must be able to work under pressure and meet deadlines.
Self-motivated with the ability to work independently and to carry out assignments to completion within parameters of instructions given, established timeframes and standard accepted practices.
Familiar with Joint Commission, NCQA, Centers for Medicare/Medicaid (CMS) and other accrediting agency standards.
Demonstrate attention to detail, with a high degree of accuracy and organizational ability, have strong and effective verbal, written and interpersonal communication skills required.
Knowledge in MS Office, office equipment, computer systems, and office administration.

Nice To Haves

Certified Provider Credentialing Specialist CPCS or CPMSM certification through NAMSS preferred.
MN Association Medical Staff Services (MAMSS) membership preferred.

Responsibilities

Preparing files for medical staff credentialing and privileging for CentraCare within the Clinical Partner Resource Office.
Accurately and efficiently completing medical staff credentialing, privileging and recredentialing processes in compliance with regulatory requirements.
Following up on red flag issues in files in collaboration with physician and advanced practice provider reviewers.
Presenting files at system-wide Credentialing Committee for discussion and review.
Completing accurate data entry of demographics, education, training, prior hospital affiliations and employment verifications into the credentialing database.
Communicating with practitioners and hospital staff by phone, fax, or email to facilitate the completion or clarification of credentialing and privileging documents.
Engaging in activities to develop and improve documents, policies and procedures to support day-to-day operations.
Ensuring compliance with the Joint Commission, NCQA, Centers for Medicare/Medicaid Services, and other laws or Hospital policies.