Credentialing Specialist

Position Title

Credentialing Specialist

Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers through the evaluation, analysis, and coordination of all aspects of the credentialing and recredentialing processes for practitioners practicing within the Western

U Health System clinical entities.

• Strong working knowledge of healthcare provider credentialing process
• Experience working with Windows based applications:
  Excel, Word, Outlook, Share Point
• Significant knowledge of State and Federal Regulatory requirements and accreditation standards, e.g., NCQA, NPDB, Title XXII, CAQH and NPPES related to healthcare provider credentialing
• Considerable working knowledge of credentialing management applications, e.g., Verity Stream
• Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization, and computer skills
• Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
• Demonstrated attention to detail and good organizational capability.
• Able to handle multiple simultaneous tasks and complete work projects in designed time frames.
• Demonstrate a commitment to working in an organization that values and promotes humanism.

• Education:
  
  High School Diploma or equivalent.
• Experience:
  
  Minimum of two years of relevant experience in provider credentialing.

• Preference will be given to individuals with NAMSS Certification as Certified Provider Credentialing Specialist ( CPCS ) certification.
• A background in clinical academic setting is highly preferred.

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
• Prepares documents for primary source verification process, collects, and validates documents to ensure accuracy of all credentialing elements.
• Assesses completeness of information and qualifications relative to credentialing standards and Western
  
  U Health System criteria.
• Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other peculiarities that could adversely impact ability to credential and enroll practitioners.
• Discovers and conveys problems to Executive Director University Compliance and Chair of Provider Credentialing Committee for sound decision making in accordance with credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
• Prepares and provides information to internal and external customers as appropriate.
• Enter, updates, and maintains data from provider applications into credentialing database, focusing on accuracy, and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Submits and responds to requests for required documentation to third-party payors for credentialing/recredentialing.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process.
• Prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
• Communicates clearly with providers, their liaisons, Clinical Deans and Western
  
  U Health Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Performs miscellaneous job-related duties as assigned.

• Monday-Friday, 8 AM
  -5 PM.

• Competitive salaries, generous paid time off, insurance plans, reimbursements, and retirement benefits.
• 100% focus on student success.
• College culture creates a nurturing and supportive environment.
• Faculty, staff, and students can expect to make deep, personal relationships within the University community.
• Work that you love, be authentic and lead to the future with innovation in health sciences.
• Core value of humanism encourages all to bring their whole self in all that they do.
• Committed to fostering a culture of respect, equity, collaboration, and fun at all levels for all people.

• Minimum $25.00 Hourly
• Maximum $28.00 Hourly

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