Credentialing & Privileging Specialist

Rhode Island Hospital; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

Brown University Health System is seeking a Credentialing Specialist to support the credentialing and privileging process for medical and allied health staff across Brown University Health System facilities, including hospitals, clinics and practices. The role requires knowledge of federal and state regulations, accreditation standards, and licensing requirements.

You will process credentialing requests, prepare packets, track applications, verify data, maintain electronic records, and liaise

Qualifications

• High school diploma or equivalent; associate's or bachelor's degree preferred.
• CPCS Certification preferred.
• Excellent organizational skills and attention to detail.
• Ability to manage multiple projects with minimal supervision.
• Strong analytical ability to verify data accuracy.
• Experience with credentialing databases is a plus.

Responsibilities

• Processing of departmental credentialing requests, in accordance with established procedures and time frames.
• Preparation of initial and reappointment application packets for assigned area of responsibility.
• Tracking of initial and reapplications sent, received, and processing time.
• Take action on non-returned new and (re)applications and conducts follow-up of initial and (re)applications in accordance with policies and procedures.
• Reviews initial (re)applications for clarity, quality, and completeness of data in accordance with policies and procedures.
• Performs timely and accurate scanning, data entry/entry validation of application information received in the database.
• Initiation of the verification process within established time frames.
• Responds to verification requests as received, compares the responses with the information provided by applicant to ensure accuracy and completeness.
• Provides timely resolution of any verification problems/discrepancies in order to ensure timely completion of the verification process.
• Maintains an electronic record/file for all practitioners within the credentialing database and maintains data integrity.
• Assists with development and revision of credentialing and audit workflows within the credentialing database.
• Maintains competency on vendor database via participation in online education learning modules and monthly webinars.
• Participates in orientation of new staff members, as assigned.

Skills

Organizational skills

Analytical skills

Attention to detail

Multitasking

Education

High school diploma or equivalent

Associate/Bachelor's degree preferred

CPCS Certification preferred

Job description

Brown University Health System is seeking a Credentialing Specialist to support the credentialing and privileging process for medical and allied health staff across Brown University Health System facilities, including hospitals, clinics and practices. The role requires knowledge of federal and state regulations, accreditation standards, and licensing requirements.

You will process credentialing requests, prepare packets, track applications, verify data, maintain electronic records, and liaise