Credentialing Specialist - FT- Day Shift

SALARY RANGE: $51,638.00 - $69,863.00

DISTINGUISHING FEATURES OF THE CLASS: The work involves the gathering and analysis of primary

source verification of the credentialing and re-credentialing of applicants in accordance with all applicable accreditation standards and regulatory requirements as well as the Erie County Medical Center Corporation Medical-Dental Bylaws, Rules and Regulations and Credentialing Procedures. The incumbent ensures that all document expiration dates remain current, collates clinical department and practitioner specific quality data and provides assistance and guidance to medical-dental staff and hospital leadership to meet regulatory requirements. The work is performed under the general supervision of the Medical-Dental Staff Services Manager. Supervision is not a function of this position. Performs related work as required.

TYPICAL WORK ACTIVITIES:

Processes providers credentialing and re-credentialing applications:

Monitors the status of applications and follows up as needed through completion;

Compiles and maintains copies of current state licenses/registrations, DEA certificates, malpractice coverage and any other required credentialing documents for providers;

Maintains credential files for each member of the medical-dental staff and ensures provider information is current;

Enters provider information into credentialing software;

Scans credentialing information into appropriate provider electronic profiles;

Tracks license and certification expirations for providers to ensure timely renewal;

Acts as a liaison between the Credentialing Department and hospital departments and other internal and external customers;

Participates in the development and revision of policies and procedures for credentialing, quality assurance, professional standards and administrative functions;

Participates in performance improvement projects relative to the quality of service;

Assists with the analysis of clinical practice of medical-dental staff members;

Maintains related records and prepares reports;

Participates in meetings, committees, seminars, workshops and professional affiliations with flexibility to attend evening meetings.

FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITITES AND PERSONAL CHARACTERISTICS: Thorough knowledge of ECMCC Medical Bylaws, Rules and Regulations, and applicable federal, state and local laws, rules, regulations and accreditation standards related to medical-dental credentialing and licensure; good knowledge of credentialing procedures; good knowledge of medical terminology; ability to maintain records and prepare reports; ability to communicate effectively, both orally and in writing; ability to establish and maintain effective working relationships with a diverse constituency; ability to utilize a variety of electronic software applications; ability to maintain confidentiality regarding highly sensitive information; ability to work well under pressure and with deadlines; detail oriented; well organized; sound professional judgment; capable of performing the essential functions of the position with or without reasonable accommodate.

MINIMUM QUALIFICATIONS:

• Graduation from a regionally accredited or New York State registered college or university with an Associate's Degree and one (1) year of medical office experience *, of which included healthcare credentialing functions; or:
• Completion of sixty (60) semester credit hours from a regionally accredited or New York State registered college or university and one (1) year of medical office experience *, of which included healthcare credentialing functions; or:
• Graduation from high school or possession of a high school equivalency diploma and three (3) years of medical office experience *, of which included healthcare credentialing functions; or:
• An equivalent combination of training and experience as defined by the limits of (A), (B) and (C).

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CREDENTIALING SPECIALIST (continued....)

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NOTE 1: *Possession of certification by the National Association of Medical Staff Services for Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentials Specialist (CPCS) may be substituted for one (1) year of medical office experience.

NOTE 2: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirements.