Lead Credentialing Specialist

Cooper University Hospital•Camden, NJ

8d•$29 - $50

About The Position

Assist Credentialing Manager with the process of credentialing and re-credentialing applications for medical providers overseeing investigation and documentation of practitioner credentials and privileges and utilizing specialized knowledge to obtain verification of all aspects of practitioners’ background, training and past practice. Plans, supervises and coordinates work activities of Credentialing Assistants, which includes monitoring expiring documents work product ensuring that organization is compliant with Medical Staff Bylaws and regulatory agencies. Assists Credentialing Manager with training of new and established employees to enhance skills and knowledge of credentialing processes and use of the credentialing database. Ensure that applications are properly verified and accurately uploaded into an online credentialing database system. Assists Credentialing Manager with initial and reappointment application processes. Manages urgent/emergency applications as assigned by Manager which require completion outside of the normal processing time. Assists Credentialing Manager with training of new and established employees to enhance skills and knowledge of credentialing processes and use of the credentialing database. Plans, supervises and coordinates work activities of Credentialing Assistants, which includes monitoring expiring documents work product ensuring that organization is compliant with Medical Staff Bylaws and regulatory agencies. Evaluates performance and motivates employees to achieve peak productivity and performance. Supports the Credentialing Manager with preparation of and distribution of standing reports and ad hoc report requests from the Credentialing Database. Supports the Credentialing Manager with the Credentials Committee meetings to manage and present applicant files, preparation of agenda and packet, minutes and appropriate follow-up – specific to credentialing activities (initial applications, reappointments, increase in privileges, confirmation of appointment, etc.). In Credentialing Manager’s absence, assigns newly received initial applications to Credentialing Specialist. Sends, receives and reviews initial applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence. Identifies issues that require addition investigation and/or follow-up. Interacts with Division Head/Department Chief regarding red flags identified. Coordinates reappointment process, including but not limited to verifying all relevant information via primary source; reviewing and analyzing potential issues; and preparing files for routing to the appropriate medical staff leaders, committees and governing body. Ensures documentation is in full compliance with Medical Staff Bylaws and accrediting agencies standards (TJC, NCQA, CMS, etc.) Privileging – collects required documentation from applicants, analyzes, and ensures that documentation meets established criteria as delineated on the Privilege Delineation Form. Participates in departmental performance improvement and core process activities. Assists in the development of workflow process/procedures to ensure that all credentialing and accreditation processes are completed in accordance with relevant regulation, policies, and standards.

Requirements

0-2 year experience in credentialing within a healthcare setting.
ASSOCIATES DEGREE REQUIRED

Nice To Haves

Bachelors Preferred
Preferred Certified Provider Credentialing Specialist or Certified Professional Medical Services Management-Obtain within 7 years of employment.

Responsibilities

Assist Credentialing Manager with the process of credentialing and re-credentialing applications for medical providers overseeing investigation and documentation of practitioner credentials and privileges and utilizing specialized knowledge to obtain verification of all aspects of practitioners’ background, training and past practice.
Plans, supervises and coordinates work activities of Credentialing Assistants, which includes monitoring expiring documents work product ensuring that organization is compliant with Medical Staff Bylaws and regulatory agencies.
Assists Credentialing Manager with training of new and established employees to enhance skills and knowledge of credentialing processes and use of the credentialing database.
Ensure that applications are properly verified and accurately uploaded into an online credentialing database system.
Assists Credentialing Manager with initial and reappointment application processes.
Manages urgent/emergency applications as assigned by Manager which require completion outside of the normal processing time.
Evaluates performance and motivates employees to achieve peak productivity and performance.
Supports the Credentialing Manager with preparation of and distribution of standing reports and ad hoc report requests from the Credentialing Database.
Supports the Credentialing Manager with the Credentials Committee meetings to manage and present applicant files, preparation of agenda and packet, minutes and appropriate follow-up – specific to credentialing activities (initial applications, reappointments, increase in privileges, confirmation of appointment, etc.).
In Credentialing Manager’s absence, assigns newly received initial applications to Credentialing Specialist.
Sends, receives and reviews initial applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence.
Identifies issues that require addition investigation and/or follow-up.
Interacts with Division Head/Department Chief regarding red flags identified.
Coordinates reappointment process, including but not limited to verifying all relevant information via primary source; reviewing and analyzing potential issues; and preparing files for routing to the appropriate medical staff leaders, committees and governing body.
Ensures documentation is in full compliance with Medical Staff Bylaws and accrediting agencies standards (TJC, NCQA, CMS, etc.)
Privileging – collects required documentation from applicants, analyzes, and ensures that documentation meets established criteria as delineated on the Privilege Delineation Form.
Participates in departmental performance improvement and core process activities.
Assists in the development of workflow process/procedures to ensure that all credentialing and accreditation processes are completed in accordance with relevant regulation, policies, and standards.