Credentialing Specialist

ECU Health Medical Center•Greenville, NC

1d•$22 - $31•Remote

About The Position

The Credentialing Specialist performs primary source verification, enters verification information into a data repository, and makes available verification information to the facilities for processing and acceptance in accordance with the facility's applicable Bylaws, Rules, Regulations and Policies. This role operates under minimal supervision and follows procedures for appointment and clinical privileges as outlined in the ECU Health Policies and Procedures. The specialist independently performs primary source verifications for initial credentialing and reappointment applications using various sources like the National Practitioner Data Bank (NPDB), Federation of State Medical Boards (FSMB), American Board of Medical Specialties (ABMS), and applicable Medical Boards. They also obtain verifications through publication review, electronic access, telephone calls, or written correspondence. The role involves communicating the status of credentialing applications and enrollment to all constituents in a timely manner, processing applications to complete the credentialing and reappointment process, accurately entering provider data in the CVO database, and providing feedback on applicant status. Identifying and communicating red flags, potential issues, or processing delays related to provider credentialing applications to the appropriate parties, and obtaining clearance from legal or entity representatives are key responsibilities. Additionally, the specialist obtains and reviews provider immunization history for compliance with ECU Health's Medical Staff Occupational Health requirements, informs providers of needed immunizations, and communicates with applicable Medical Staff Professionals. An initial assessment of assigned files is completed within 48-72 hours of receipt, with documentation of missing items entered into the CVO Database three times weekly until the file is released. The role ensures the accuracy of applications and supporting documents, communicates professionally with applicants, corporate staff, and external agencies, and performs timely follow-up on required information. Preparing credentialing files for quality audits, managing time effectively, prioritizing assignments, coordinating functions, and maintaining confidentiality are also crucial. The specialist performs other assigned duties with minimal supervision and participates in departmental functions, working in harmony with all personnel, promoting efficient service delivery, performing departmental projects, participating in performance improvement activities, attending required educational offerings, demonstrating departmental and professional growth, and operating standard office equipment.

Requirements

Zero to two years related experience.
Business or Healthcare related education.
Knowledge of The Joint Commission (TJC) and NCQA (National Committee for Quality Assurance) guidelines, state regulations, and proficiency with Visual Cactus.
Ability to take direction, organize and professionally manage demanding workload, even during high stress situations and peak workloads.
Excellent verbal and written communication skills with editing and proofing experience.
Must have the ability to problem-solve, make decisions, and implement same with minimal supervision.
Must have demonstrated ability to handle phone, email and personal interactions in an efficient and professional manner.
High School or Equivalent (GED) or higher.

Responsibilities

Under minimal supervision, follows procedures for appointment and clinical privileges as outlined in the ECU Health Policies and Procedures.
Independently performs primary source verifications of documentation required for initial credentialing and reappointment applications through sources such as the National Practitioner Data Bank (NPDB), Federation of State Medical Boards (FSMB), American Board of Medical Specialties (ABMS) and applicable Medical Boards. Will also obtain verifications through publication review, electronic access, telephone calls, or written correspondence to appropriate agencies, universities and hospitals.
Communicates the status of credentialing applications and enrollment to all constituents in a timely manner. Processes applications to complete the credentialing and reappointment process, accurately enters provider data in the CVO database according to established departmental processes and provides feedback to other entities of the applicant's status.
Identify red flags and or potential issues or processing delays related to provider credentialing applications. Communicates issues with the appropriate parties and obtains clearance from legal and/or the entity representatives as appropriate.
Obtains and reviews provider immunization history to determine compliance with ECU Health's Medical Staff Occupational Health requirements. Informs the provider if additional immunizations are needed and communicates with the applicable Medical Staff Professionals.
Completes an initial assessment of assigned files within 48-72 hours of receipt. After initial review enters documentation of missing and incomplete items three times weekly into the CVO Database until the file is released to the entity. Determines additional supporting documentation required from applicant, as well as, the applicable provider representative. Ensures the accuracy of applications and supporting documents.
Communicates professionally in both verbal and written form to applicant, corporate staff, and external agencies. Performs timely follow-up on required information (expired licenses, board certifications, insurance, DEA registrations, and other documents).
Prepares credentialing files for quality audits performed by the CVO Quality Assurance Coordinator or Controller.
Manages time, prioritizes assignments and coordinates functions effectively. Maintains confidentiality of all information related to credentialing and re-credentialing.
Performs other duties and responsibilities as assigned with minimal supervision and within time-frame specified.
Works in harmony and unison with all personnel within the department and throughout ECU Health.
Promotes and assists in the smooth; efficient delivery of departmental services to providers, other ECU Health departments, and outside agencies.
Performs needed departmental projects.
Participates in performance improvement activities.
Attends all required educational offerings annually.
Demonstrates departmental and professional growth.
Operates personal computer, copy machine, and fax machine.
It is the responsibility of each employee to ensure a safe and productive work environment.