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Credentialing Specialist

Fairfield County CT

Posted: 10/31/2018 Department: Healthcare Finance and Operations Job Number: 5107

Title: Credentialing Specialist

Location: Fairfield County, CT

Industry: Healthcare

Occupational Category: Finance

Hours: Full-time

Description: Hiring a Credentialing Specialist for a non-for-profit community teaching hospital in Connecticut. The Credentialing Specialist will be responsible for managing the daily operations of the Medical Staff Services department to develop, manage, and monitor the ongoing processes and procedures that support credentialing, recredentialing, privileging, and other functions.

Responsibilities:

  • Serve as the principal resource for compliance in the credentialing program with internal and external standards, including accrediting and regulatory bodies
  • Act as Liaison and facilitate interactions between medical staff, administration, and other departments.
  • Collaborate with the Manager of Peer Review to ensure timely completion of FPPE and OPPE for privileged practitioners.
  • Manage appropriate, compliant, and timely assessment of applications for appointments, reappointments, change in status, delineation of privileges, and other associated credentialing functions.
  • Manage and attend the Credentials Committee, Ancillary Credentials Committee, Quarterly Medical Staff Meetings and other meetings as appropriate.
  • Assures integrity of data entry and data quality of credentialing and privileging electronic and paper files.
  • Collect medical staff dues and manage the dues fund.
  • Participate in Joint Commission accreditation preparation. Review, prepare, and present credential files for State and regulatory agencies audits.
  • Lead and coordinate new physician orientation for credentialed practitioners.
  • Manage a variety of project activities relating to credentialing and privileging including process improvement, development and posting of policies and procedures, maintaining medical staff and credentialing documents.
  • Perform functions of an office manager

Education Requirements:

  • Bachelor’s Degree preferred.
  • Valid Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management credentials is required.

Experience Requirements:

  • Minimum of 3 years of work experience in credentialing preferably in a hospital setting. Experience with The Joint Commission preferred.
  • Demonstrated working knowledge of the healthcare and credentialing industry.
  • Experience in project management is preferred.
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