Sr. Credentialing Specialist

Albany Medical Center • City of Albany, NY

1d • Onsite

About The Position

This position supports the Albany Med Health System (Affiliates) Medical Staff Office and the Centralized Verification Office (CVO) and will be located at Columbia Memorial Hospital. Evaluates, analyzes, and coordinates all aspects of the Medical Staff and Delegated Credentialing and Re-Credentialing processes for practitioners practicing within the Albany Med Health System & its Affiliates. Will serve as a liaison between internal clients and functional department including Albany Med Health System's ongoing auditing & monitoring of credentials files.

Requirements

• Associate's Degree - required
• 4-6 years experience in Medical Staff, Medical Staff Operations or Managed Care credentialing - required
• Proficiency in MSOW, credentialing software database preferred
• Strong Interpersonal, communication, organizational skills (extensive work and collaboration with other organizations)
• Ability to work effectively and cooperatively with both internal and external individuals, departments, and agencies
• Able to communicate effectively at all levels within the organization and with external customers and agencies.
• Creates a collegial and collaborative environment among all members of the healthcare team.
• Demonstrates responsibility and accountability for decisions.
• Identifies problems, gathers data, establishes facts, and draws valid conclusions.
• Possesses knowledge of quality concepts, principles, and problem-solving tools and techniques and demonstrates ability to apply in support of departmental process and quality improvement.
• Knowledge of TJC requirements in conjunction with credentialing principles
• Ensures compliance with the accrediting agencies (i.e., NCQA, JCAHO, NYS DOH, NYS DOE, CMS and Federal laws)

Nice To Haves

• Bachelor's Degree in Business Administration or related field - preferred
• Expertise with NCQA Credentialing Standards, Compliance
• Familiarity with Managed Care Health Insurance Plans, credentialing, and enrollment procedures
• Credentialing Verification Office, Payer credentialing experience a plus.
• Certified Provider Credentialing Specialist (CPCS) Upon Hire - preferred
• Certified Medical Professional Services Management (CPMSM) Upon Hire - preferred

Responsibilities

• Gathers and synthesizes data for Department Chairs applicants
• Participates in System wide Credentialing Committee
• Participates in Medical Staff Credentialing Committee
• Actively participates in planning and improving application Process Metric
• Ensure through audits that the Albany Med Health System's programs are consistently administered in compliance with Albany Med Health System and organizational policies and procedures, delegation and contractual obligations, rulings, laws, and government regulations
• Assists with onboarding and training of new credentialing associates

Benefits

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree