Credentialing Specialist (Remote)

Credentialing Specialist Position Summary: The Credentialing Specialist is responsible for all aspects of the credentialing and reappointment process for OBHG clinicians in their assigned book of business.  The Credentialing Specialist will process applications, verify information, research application details, and assure processes are in accordance with medical staff bylaws.  The Credentialing Specialist will provide consistent, accurate, and timely credentialing support, enhancing the organization’s ability to provide professional services by ensuring clinicians are credentialed at all hospital programs in which they are intended to work.

Credentialing Specialist Responsibilities:  Essential

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Privileging and Reappointments 

• Responsible for the processing and preparation of the applications for privileges on Hospital Medical Staff:
  • Examines, researches, enters data, files, and gathers all required documentation from clinicians to support the credentialing process
  • Completes clinician credentialing and reappointment applications; monitors application progress and follows up as needed.
  • Assists when needed in obtaining verifications for medical school, residency, fellowship, NPDB, work history, peer references, etc.
  • Maintains consistent communication with clinicians during the credentialing process as the application progresses through various phases of approval
  • Tracks critical dates of the hospital privileging process including Credentialing Committee, Medical Executive Committee, and Board meeting to meet credentialing timelines
• Establishes and maintains professional relationships with clinicians, Medical Staff Office personnel, OBHG support team, and other affiliates.
• Manages multiple clinician credentialing requirements simultaneously.
• Adheres to the standards of hospital by-laws for verification of clinician credentialing requirements, including but not limited to licenses, certifications, registrations, and educational degrees.
• Maintains and updates internal database (CRM) for OBHG clinicians and candidates regarding the credentialing process.
• Escalates non-responsiveness of clinician or Medical Staff Office to Supervisor and internal stakeholders for resolution
• Coordinates with staffing agencies in the credentialing process for locum and per diem clinicians, providing assistance where needed

Clinician Record Management

• Responsible for the maintenance and accuracy of electronic clinician employee credentialing files:
  • Collects and processes significant amounts of documents required for verification
  • Maintains and updates databases for both practitioners and facilities.
  • Compiles and maintains current and accurate data for clinicians, including current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents.
  • Tracks medical licensure and DEA certification for all clinicians to ensure timely renewals.
  • Enrolls new clinicians in National Practitioner Database – Continuous Query
  • Maintain and update reports as requested.

Clinician Onboarding

• Responsible for scheduling hospital orientation and coordinating with clinicians.
• Responsible for communicating hospital training requirements related to credentialing or reappointment to clinicians. 

Operational Support

• Participates on internal Matrix Team Calls to provide updates on candidates in the credentialing process
• Participates on Program Implementation Calls to provide updates on candidates in the credentialing process
• Collaborates with Payor Enrollment Team to obtain Medicaid and Medicare signature pages and documentation of such in the Echo database

Performs other duties as assigned.

Essential Skills/Credentials/Experience/Education for Credentialing Specialist Position

• A minimum of a High School Diploma is required; an associate’s degree is preferred.
• Ability to organize and prioritize work and manage multiple priorities.
• Effective time management and ability to meet regular time sensitive deadlines.
• Ability to produce work in high quantity and quality.
• Excellent written and verbal communication skills, including letters, memos, and emails.
• Excellent attention to detail.
• Works with initiative, energy, and effectiveness in a fast-paced environment.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with clinicians, management, medical staff office personnel, and other contacts outside of the organization.
• Knowledge of clinician credentialing criteria and processes in accordance with NCQA, JCAHO standards, NPDB guidelines, and general licensing requirements.
• Ability to uphold the principles of compliance as outlined by the company.

Preferred Skills/Credentials/Experience/Education for Credentialing Specialist Position

• Certified Provider Credentialing Specialist (CPCS) by the National Association of Medical Staff Services (NAMSS) preferred.
• Two years of credentialing experience required.
• Strong computer skills, proficient in Word, Excel & Access.
• Preferred understanding of medical terminology.
• Preference will be given to candidates who have worked in a Medical Staff Office.

Mental and Physical Demands (per ADA guidelines) of Credentialing Specialist Position

Physical Demands:

• Sitting for long periods of time. Occupation requires this activity more than 66% of the time (2.6+ hrs/day).
• Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
• Regularly required to use computer keyboard, mouse and telephone.

Compensation: $28 - $30 per hour (Hourly, Nonexempt position) + Incentive Plan

What We Offer - The Good Stuff:

• A mission based company with an amazing company culture.
• Paid time off & holidays so you can spend time with the people you love.
• Medical, dental, and vision insurance for you and your loved ones.
• Health Savings Account (with employer contribution) or Flexible Spending Account options.
• Paid Parental Leave
• Employer Paid Basic Life and AD&D Insurance.
• Employer Paid Short- and Long-Term Disability.
• Optional Short Term Disability Buy-up plan.
• 401(k) Savings Plan, with ROTH option.
• Legal Plan.
• Identity Theft Services.
• Mental health support and resources.
• Employee Referral program – join our team, bring your friends, and get paid.