Credentialing Specialist

Position Description:

Position Duties:

1. Credentialing Oversight:

• Manage the end-to-end credentialing process for healthcare providers, including initial applications, re-credentialing, and ongoing monitoring.
• Stay abreast of industry regulations and accreditation standards to ensure compliance in all credentialing activities.
• Collaborate with internal departments to gather necessary documentation and information for credentialing purposes.

2. Project Management:

• Utilize project management methodologies to streamline and enhance the credentialing process.
• Develop and implement project plans, timelines, and milestones to ensure efficient and timely completion of credentialing tasks.
• Identify and address bottlenecks in the credentialing workflow through effective project management strategies.

3. Quality Assurance:

• Conduct regular audits and quality checks to verify the accuracy and completeness of credentialing files.
• Implement continuous improvement initiatives to enhance the efficiency and effectiveness of the credentialing process.

4. Communication and Collaboration:

• Communicate effectively with healthcare providers, internal staff, and external organizations to gather necessary information and resolve credentialing issues.
• Collaborate with cross-functional teams to integrate credentialing processes seamlessly with other organizational functions.

Position Requirements:

1. Education and Certification:

• Bachelor's degree in healthcare administration, business, or related field.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) certification is preferred.

2. Experience:

• Minimum of 3 years of experience in medical credentialing.
• Proven track record in project management, with experience in developing and implementing project plans.

3. Knowledge and Skills:

• In-depth understanding of credentialing standards, regulations, and best practices.
• Strong project management skills with the ability to manage multiple projects simultaneously.
• Excellent organizational and analytical skills, with attention to detail.

4. Communication Skills:

• Exceptional written and verbal communication skills.
• Ability to effectively communicate with internal and external stakeholders.

5. Technology Proficiency:

• Proficient in using credentialing software and Microsoft Office Suite.

6. Adaptability:

• Ability to adapt to changes in regulations and industry standards.
• Willingness to embrace new technologies and methodologies for process improvement.