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Job Title
Credentialing Specialist
Department
University Hospital | Credentialing Services
Position Summary
The Delegated Credentialing Specialist will assume total responsibility for all aspects of provider credentialing/privileging and recredentialing/reprivileging, assuring compliance with NCQA, TJC, CMS, and other regulatory or accreditation bodies, and insurance companies (delegated credentialing), including:
- Initiate and monitor the provider corporate credentialing functions to assure that all practitioners are credentialed in accordance with established thresholds.
- Perform and evaluate primary source verification and medical staff privileging assuring compliance with NCQA and TJC standards.
- Assists with special projects for providers, which may include assisting with credentialing process for other healthcare institutions when a business relationship exists.
- Providing assistance to other credentialing staff during high volume periods to ensure completion of applications/projects.
- Perform ongoing credentialing for other healthcare institutions that have contracted Corporate Credentialing to perform their primary source verification (as a CVO business initiative).
- Liaison with practitioners, departments/divisions, and clients regarding areas of responsibility.
- Utilize excellent verbal and written communication skills, working independently, while managing multiple priorities.
- Utilize resources effectively, including the internet, while maintaining costs associated with credentialing.
- Initiate and maintain positive relationships with providers, clients, co-workers, and departments.
Minimum Qualifications
- Bachelor’s degree (preferably in healthcare field)
- Minimum two years’ experience, in a hospital setting and/or managed care setting, or equivalent combination of education and experience
Our Comprehensive Employee Benefits Include
- An array of retirement plan options, each with a generous employer contribution.
- Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
- Paid vacation and sick leave, including short and long-term disability and paid parental leave.
- Get the most out of the Public Service Loan Forgiveness program.
- And much more!
