Credentialing Consultant

The Ohio State University; United States; On-site; USD 70,000 - 110,000; Full time

Job summary

The Ohio State University is seeking a Credentialing Consultant for University Hospital's Credentialing Services. The role leads the delegated credentialing operations and ensures efficient management of the Corporate Credentialing Office functions.

Responsibilities include overseeing non-physician credentialing and privileging, FPPE/OPPE processes, database management, and ongoing verification of licenses and certifications.

Qualifications

• Bachelor’s degree or equivalent with strong supervisory and writing skills.
• Minimum five years in a hospital setting, preferably in Medical Staff Services.
• Familiarity with medical staff management software is desired.
• Background check and drug screen may be required.

Responsibilities

• Lead and oversee corporate credentialing services for OSU hospitals.
• Manage non-physician credentialing, privileging, FPPE/OPPE processes.
• Coordinate delegated credentialing, contracts, and liaison with MCO/OSUWMC.
• Oversee credentialing database management and data entry.
• Audit credentialing files per guidelines, TJC, and NCQA.
• Track licenses, DEA, board certifications, and regulatory requirements.
• Coordinate CAQH database management and provider identification.
• Facilitate physician licensure applications with OSBM, FCVS, and FSMB.
• Supervise staff and ensure confidentiality; communicate effectively.

Skills

Supervisory and management skills

Communication skills

Written communication

Interpersonal skills

Confidentiality handling

Education

Bachelor’s Degree in Medical Staff Sciences

Experience in hospital credentialing or medical staff services

Master’s Degree (preferred)

Job description

Job Title:

Credentialing Consultant

Department:

University Hospital | Credentialing Services

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

Location:

Ackerman Rd, 700 (0921)

Position Type:

Regular

Scheduled Hours:

40

Shift:

First Shift

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.