Credentialing Specialist I - Professional Staff

GENERAL SUMMARY

The Credentialing Specialist I reports to the Director of Professional Staff and is responsible for supporting departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and primary source verifications, as well as ensuring compliance with Bylaws, Rules and Regulations, State and Federal requirements, and accreditation standards. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility. This individual may also be mentored by any Credentialing Specialist II within the department. Actively seeks to promote and maintain, through interactions with others within and outside the department, a positive, professional, team‑oriented, and service‑conscious environment that contributes to the goals of the department and reflects the values and mission of CHKDHS.

ESSENTIAL DUTIES AND RESPONSIBILITIES

CONDUCTS, PARTICIPATES IN, AND MAINTAINS PRIMARY SOURCE VERIFICATION

• Perform outreach to primary sources for practitioners’ information. Obtain and evaluate information from primary sources.
• Perform detailed and thorough review of applications, primary source verifications, and sources provided.
• Recognize potential discrepancies and adverse information, and independently investigate and validate information applications, primary source verifications, or other sources.
• Verify and document expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
• Serve as main point of contact for external queries regarding practitioners’ status, providing responses in a timely matter.

CONDUCTS, PARTICIPATES IN, AND MAINTAINS CREDENTIALING AND PRIVILEGING

CONDUCTS, PARTICIPATES IN, AND MAINTAINS CURRENT CLINICAL COMPETENCY EVALUATIONS AND PEER REVIEW

COMPLIES WITH ACCREDITATION AND REGULATORY STANDARDS

MANAGES COMPLIANCE WITH STATE AND FEDERAL ACCREDITATION STANDARDS AND REGULATORY REQUIREMENTS

MANAGES DEPARTMENTAL OPERATIONS

FACILITATES MEDICAL STAFF FUNCTIONS

ANALYZES AND MANAGES DATA

LICENSES AND / OR CERTIFICATIONS

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

WORKING CONDITIONS

Fast‑paced, extremely busy office environment where interruptions are frequent. Works in a normal office environment with little exposure to excessive noise, dust, temperature and the like.

PHYSICAL REQUIREMENTS

Click here to view physical requirements. #CHKDHP

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