Posted Aug 08, 2024 146 views
The Senior Credentialing Specialist oversees the credentialing process for healthcare professionals within the organization. This role ensures compliance with regulatory standards and organizational policies while maintaining high-quality documentation and efficient workflow. The ideal candidate will have extensive experience in credentialing, excellent attention to detail, and strong communication skills.
Key Responsibilities:
- Manage the credentialing and re-credentialing processes for healthcare providers, including physicians, nurses, and allied health professionals.
- Verify and evaluate the qualifications of applicants, ensuring adherence to state and federal regulations and organizational policies.
- Maintain accurate and up-to-date credentialing files and databases, including primary source verification.
- Collaborate with medical staff leadership and other departments to facilitate the credentialing process.
- Provide training and support to junior staff members in credentialing practices and procedures.
- Prepare and present reports on credentialing activities and compliance metrics to management.
- Stay informed about changes in healthcare regulations and best practices related to credentialing.
- Assist in the development and implementation of credentialing policies and procedures.
- Respond to inquiries from healthcare providers, regulatory agencies, and internal stakeholders regarding credentialing status and requirements.
Qualifications:
- Bachelor’s degree in healthcare administration, human resources, or a related field (Master’s preferred).
- Minimum of 5 years of experience in credentialing within a healthcare setting.
- Knowledge of accreditation standards (e.g., Joint Commission, NCQA) and regulatory requirements.
- Strong analytical skills and attention to detail.
- Excellent written and verbal communication skills.
- Proficiency in credentialing software and Microsoft Office Suite.
- Certification as a Credentialing Specialist (CPCS) or similar credentialing certification is preferred.
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