Credentialing Consultant

The Ohio State University Wexner Medical Center; Columbus (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

The Ohio State University Wexner Medical Center is seeking a Delegated Credentialing Consultant to lead and oversee credentialing operations for OSU hospital corporate services. You will supervise processes for non-physician credentialing, FPPE/OPPE, and delegated credentialing with contracting and MCO liaison activities under the direction of senior leadership.

This role requires managing credentialing databases, audits, and verification of licenses, board certifications, and regulatory

Qualifications

• Bachelor's level degree or equivalent required.
• Strong supervisory, management, communication and writing skills.
• Minimum of five years of hospital experience, preferably in Medical Staff Services.
• Intermediate computer knowledge. Familiarity with medical staff management software desired.

Responsibilities

• Manage non-physician provider credentialing and privileging.
• Oversee non-physician FPPE and OPPE processes.
• Coordinate delegated credentialing functions with MCO and OSUWMC Managed Care Contracting; provide flat files per contracts.
• Manage credentialing database and auditing of files per guidelines.
• Audit credentialing/recredentialing files per standards (TJC, NCQA).
• Enter/audit privileges into credentialing database for CPD interface.
• Oversee verification of licenses, DEA, board certs and other regulatory requirements.
• Manage tracking of GME trainee certificates; liaise with OSMB.
• Manage CAQH database for OSUWMC; track new providers and IDs.
• Manage physician licensure applications; liaison with OSMB, FCVS, FSMB.

Skills

Supervisory

Management

Communication

Writing

Computer literacy

Confidentiality

Education

Bachelor's degree in Medical Staff Sciences

Masters degree preferred

Tools

Medical staff management software

Job description

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Position Summary

The Delegated Credentialing Consultant leads, directs, monitors, and provides oversight and leadership to ensure operating efficiencies of the corporate credentialing services of the OSU hospitals, under the supervision of the Associate Director of Corporate Credentialing and/or Administrative Director. This position is responsible for management of operational activities related to the various functions that are required of the Corporate Credentialing Office and the CVO (Credentials Verification Organization) and for delegated credentialing requirements. This position is responsible for one or more of the specialty areas below:

• Management of non-physician provider credentialing and privileging
• Management of non-physician FPPE and OPPE processes
• Management of delegated credentialing functions to include contracting, ongoing communication/liaison with MCO and OSUWMC Managed Care Contracting; provision of flat files in accordance with MCO contracts
• Credentialing database management
• Management of auditing of credentialing/recredentialing files in accordance with established guidelines, TJC standards, and NCQA requirements
• Management of data entry/auditing of privileges into credentialing database for interface to CPD
• Management of ongoing verification of licenses, DEA, board certifications, other licensing/regulatory requirements as mandated by law, regulation, accreditation standard, policy, or established standard
• Management of tracking/auditing of graduate medical education trainee certificates; liaison with OSMB
• Management of CAQH database on behalf of OSUWMC and tracking of new providers and assignment of OSUWMC Identification
• Management of physician licensure application process; liaison with OSMB, FCVS, and FSMB

Required Qualifications

Bachelor's Level Degree or equivalent combination of education and experience. Bachelor degree in Medical Staff Sciences or equivalent courses, training and experience required. Strong supervisory, management, communication and writing skills. Minimum of five years of experience in hospital setting, preferably in the Medical Staff Services office. Intermediate computer knowledge. Familiarity with medical staff management software desired. Must be able to handle highly confidential information. Strong interpersonal and motivational skills. Certification as a Provider Credentialing Specialist preferred (CPCS) or Medical Staff Coordinator (CMSC). Masters degree preferred.

Additional Education Desired

Master's Degree or equivalent combination of education and experience

FUNCTION: Health Care Administration
SUB FUNCTION: Delegated Credentialing
CAREER BAND: Individual Contributor - Specialized
CAREER LEVEL: 4

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Thank you for your interest in working at Ohio State.

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

The university is an equal opportunity employer, including veterans and disability.