Job Description

• The Credentialing Specialist is responsible for facilitating all aspects of provider credentialing, including initial appointment, reappointment, credential audits, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers as outlined in the corporate policy and procedures, or hospital bylaws.



• Utilize MDStaff credentialing software application to perform and monitor all credentialing/background checks, while maintaining accuracy and data integrity.



• Responsible for interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

• Credentialing: Responsible for all aspects of provider credentialing and re-credentialing.
  
  
  
  • License Renewals: Ensures that physician licenses are renewed prior to expiration.
  
  
  
  • Primary Source Verification: Completes primary source verification for new and existing providers to ensure due diligence.
  
  
  
  • Records Management: Maintains assigned physician files, updating each item/action as processed.
  
  
  
  • Utilizes database status/alert and other report functions, software tools and links to scanned documentation.
  
  
  
  • Ensures that information is current and accurate.
  
  
  
  • Credentialing Standards: maintains consistency in database entry to ensure accurate and consistent processes.
  
  
  
  • Back-up Coverage: provide credentialing back-up for other members of the credentialing group.
  
  
  
  
  

• AUDIT



• COMPLIANCE/REGULATORY



• DATABASE

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