Minimum Education
Bachelor's Degree (Required)
Master's Degree (Preferred)

Minimum Work Experience
3 years of credentialing experience (Required)

Required Skills/Knowledge
Excellent written and verbal communication skills, detailed knowledge of medical staff credentialing.
Knowledge of various accreditation standards (JC, NCQA, AAAHC, DOH) and State laws
Knowledge of ECHO (or equivalent) Credentialing Data System preferred

Required Licenses and Certifications
Certified Provider Credentialing Specialist CPCS and CPMSM 2 Yrs (Required)

Functional Accountabilities
Credentialing

• Supervises day to day activities of the credentialing services staff.

• Ensures that processes function smoothly and timely

• Develops departmental guidelines to ensure compliance with the Medical Staff Bylaws

• Oversees processes and minutes for CC.

• Provides updated credentials committee actions to managed care for submission to the various payer's

• Handles delegated credentialing audits. Develops responses and action plans as needed. Submits results to manager, medical affairs for the Credentials Committee.

Program and Service Administration and Implementation

• Supervises processing of initial appointments and reappointments.

• Conducts audits of completed appointments and reappointment applications.

• Provides education and feedback to staff.

• Prepares files for credentials committee actions.

• Develops automated processes in ECHO for appointments and reappointments.

Compliance

• Develops process to ensure that all providers maintain current licensure, health attestations, certifications and insurance certificates.

• Provides list of providers to be deferred monthly for medical staff action.

• Develops automated processes in ECHO for tracking licensure, etc. and sending notifications.

Customer Service

• Supervises staff in physician on-boarding, to include assisting new doctors in application process for obtaining appropriate licensure, as well as medical staff privileges.

• Develops and applies metrics around time of hire, medical staff application date, licensure application, licenses granted and medical staff privileges approved.

• Trains staff in customer service activities and maintains high level of customer service.

• Develops automated processes in ECHO to assist in on-boarding process.