Credentialing 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

SUMMARY

Reporting jointly to the Credentials Coordinators and the Credentials Manager, this position provides facilitation of the requirements of the regulatory and accreditation standards that govern the credentialing and privileging of the medical and allied health staff of all Brown University Health System facilities which include community hospitals, clinics and outpatient services as well as BHMG group practices. The position requires a background with working knowledge of the federal and state regulations, various accreditation standards and licensing requirements for the professional staff as they govern the credentialing, privileging and peer review process.Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

Core Success Factors

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

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.
• Takes 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.
• Conducts follow-up on missing data and/or discrepancies and other potential problems, reporting to MSSD coordinators and leadership as well as entity contact when appropriate in accordance with established time frames, working to ensure the completion of the verification process within established time frames to allow time to complete the committee reviews prior to anticipated appointment/next reappointment date.
• Keeps applicants (initial and reappointment) informed of the status of credentialing process which includes timely use of all correspondence as well as proper notification to the applicant.
• Serves as a liaison with other internal/external customers as it relates to practitioner related issues and concerns.
• Maintains an electronic record/file for all practitioners within the credentialing database giving attention to operational concerns and the need for others to retrieve the same records.
• Maintains integrity of electronic, specialized database, which includes the entering and importing of practitioner information in accordance with departmental policies and procedures.
• Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation.
• Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database.
• Assists with the development and revision of the credentialing and audit workflows within the credentialing database.
• Maintains competency on vendor database via participation in online education learning modules and monthly skills related webinars.
• Maintains competency on nationally recognized credentialing related initiatives through participation with NAMSS and MAMSS, journal articles, and other industry related news.
• Participates in the orientation of new staff members, as assigned.
• Performs other duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION

• High school diploma or equivalent. Associate's or Bachelor's Degree in a related field preferred.
• CPCS Certification preferred.

EXPERIENCE

• Organizational skills required to handle high data flow and to prioritize tasks in order to meet cyclical deadlines.
• Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision.
• Analytical skills necessary to determine whether correct and complete information was provided on applications.
• Able to concentrate on tasks, paying meticulous attention to detail.
• Ability to manage multiple projects/tasks while ensuring appropriate follow-up is completed and deadlines are met.
• Possesses ability to manage specialized database, including production of reports covering the area of responsibility.
• Adheres to profession