Credentialing Specialist

AtlantiCare; Atlantic City (NJ); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

PTO

Medical Insurance

Retirement Plan

Disability Insurance

Life Insurance

Tuition Reimbursement

FSAs

Wellness Programs

Pet Insurance

Job summary

AtlantiCare is seeking a Credentialing Specialist to support credentialing, privileging, and verification activities across practitioners. You will collaborate with medical leadership to ensure compliance with accreditation standards and internal policies.

The role involves data maintenance, primary source verification, and responding to inquiries about practitioner status. Ideal candidates have credentialing experience, strong communication skills, and a focus on accuracy to uphold patient

Qualifications

• CPCS and/or CPMSM credentials preferred.
• Knowledge of credentialing processes and terminology.
• Excellent oral and written communication skills.

Responsibilities

• Conducts credentialing and privileging activities.
• Maintains credentialing database for accuracy and timeliness.
• Communicates practitioner status and requirements to stakeholders.
• Reviews applications and decisions with governing bodies.

Skills

CPCS CPMSM

Attention to detail

Oral & written skills

Education

High School Diploma

Associate degree preferred

Job description

Credentialing Specialist

Job Description

POSITION SUMMARY

Supports departmental activities to ensure quality in conducting, maintaining and communicating physician and provider credentialing, privileging and verifications, in compliance with both facility and accreditation requirements. Serve as a resource to and collaborates with others to advance the quality of practitioners and patient safety. Conducts, participates in, and maintains credentialing and privileging. Determines applicant's initial eligibility for membership/participation. Complies, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies. Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information. Performs initial or reappointment/re-credentialing for eligible practitioners. Processes requests for privileges. Conducts, participates in, and maintains primary source verification. Obtains and evaluates information from primary sources. Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources. Verified and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Provides responses to external queries regarding practitioners' status. Obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance. Manages the credentialing or privileging process. Collaborates with physician leaders to develop and maintain facility-specific, criteria-based clinical privileging system in accordance with regulatory requirements, accreditation standards, and organizational policies. Applies clearly defined credentialing or privileging processes to all practitioners/providers. Directs initial or reappointment/re-credentialing process for eligible practitioners/providers. Maintains credentialing database to ensure that accurate and current information is available to all stakeholders. Maintains working knowledge and compliance with departmental policies & procedures, Medical Staff Bylaws, Rules & Regulations, the Joint Commission (TJC), National Committee for Quality Assurance (NCQA), as well as regulatory and accrediting bodies as deemed necessary by administration. Participates in an ongoing assessment of governing documents (bylaws, rules and regulations) to ensure continuous compliance. Participates in development and implementation of credentialing processes and procedures and advises supervisor of outstanding issues requiring management intervention. Other duties within the scope of the non-lead/supervisory job classification to maintain the integrity of credentialing and privileging operations as assigned by department leader.

QUALIFICATIONS

EDUCATION: High School Diploma required. Associate degree or Business school preferred.

LICENSE/CERTIFICATION: CPCS and/or CPMSM preferred

EXPERIENCE: Knowledge of computer applications required. Medical Terminology preferred. Prior credentialing experience preferred. Excellent oral and written skills required.

PERFORMANCE EXPECTATIONS

Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position. WORK ENVIRONMENT Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury. Physical and visual ability required to work computer terminal. The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

This position reports to department leadership.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

• Job Identification100907
• Job CategoryHuman Resources
• Job ScheduleFull time
• Job ShiftDay
• Pay Range$22.38-$33.57 per hour
• Holidays RequiredNo
• Weekends RequiredNo
• Hrs Per Week37.5
• Posting RequirementPost Int & Ext

Total Rewards at AtlantiCare

At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:

• Generous Paid Time Off (PTO)
• Medical, Prescription Drug, Dental & Vision Insurance
• Retirement Plans with employer contributions
• Short-Term & Long-Term Disability Coverage
• Life & Accidental Death & Dismemberment Insurance
• Tuition Reimbursement to support your educational goals
• Flexible Spending Accounts (FSAs) for healthcare and dependent care
• Wellness Programs to help you thrive
• Voluntary Benefits, including Pet Insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements.

Join a team that values your well-being and invests in your future.

Pay Transparency

In order to support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to "Pay Transparency Law" in impacted states, which mandate employers to list salary ranges in job advertisements and promotions.

AtlantiCare is an Equal Opportunity Employer

Equal employment opportunity, including veterans and individuals with disabilities.

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