Credentialing Specialist I

Processes applications for appointment, re-appointment, and mid-cycle change to the Medical Staff, House Staff, and Associate Clinical Staff and requests for clinical privileges, as applicable, in a customer-focused, efficient, comprehensive, timely, and accurate manner. Maintaining relationships and serving as a liaison between Medical Staff Services and clinical departments and divisions, and their Chief(s), enterprise-wide, to address questions and concerns.

Position Summary:
Processes applications for appointment, re-appointment, and mid-cycle change to the Medical Staff, House Staff, and Associate Clinical Staff and requests for clinical privileges, as applicable, in a customer-focused, efficient, comprehensive, timely, and accurate manner.  
Key Responsibilities:

• Reviewing and evaluating applications, including evidence of education, training, experience, and competency, to determine eligibility for membership and clinical privileges.
• Obtaining primary source verifications for all information submitted by the applicant or re-applicant.
• Recognizing, investigating, and validating discrepancies and adverse information obtained from the application, primary source verifications, or other sources; obtaining clarification and escalating concerns.
• Notifying applicants and re-applicants, and their coordinators, of any issues and maintaining contact with them throughout the process.
• Compiling, evaluating, and presenting practitioner-specific data collected for review by one or more decision-making bodies in a comprehensive and timely manner. 
• Documenting, according to policy and procedure, applicants and re-applicants with potential issues in a holistic and comprehensive manner.
• Soliciting and obtaining information from the Department or Division Chief regarding applicants and re-applicants.
• Escalating concerns, according to policy and procedure, to the chain of command. 
• Performing related credentialing functions, including ensuring all documents are maintained according to policy and procedure.
• Maintaining confidential credentialing files for all applicants and members of the Medical Staff, House Staff, and Associate Clinical Staff.
• Enrolling, maintaining enrollment, and terminating members of the Medical Staff, House Staff, and Associate Clinical Staff with the appropriate institutional malpractice carrier.
• Providing the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.
• Implementing office goals and objectives using continuous process improvement methods.
• Maintaining relationships and serving as a liaison between Medical Staff Services and clinical departments and divisions, and their Chief(s), enterprise-wide, to address questions and concerns.
• Teaching and providing expertise to managers, medical staff, and staff on credentialing processes, requirements, and regulations.
• Applying relevant Medical Staff Bylaws, Rules and Regulations, and any other relevant regulatory standards to the day-to-day functioning.
• Creating a customer-friendly and healthy work environment in support of employee engagement and well-being.
• Assisting in facilitating an efficient, productive, accountable, and customer and quality-oriented work environment using high-reliability principles.
• Providing and ensuring the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.

Education:

• Associate’s degree in the field of Medical Staff Services Science, Health Care Administration or a closely related field, or one year of basic technical training

Experience:

• One year of related experience in a hospital or healthcare environment
• One year of experience in credentialing, provider enrollment or closely related field.

Knowledge, Skills, and Abilities:

• Attention to detail, managing multiple tasks simultaneously, identifying and escalating concerns, and meticulous organization.
•  The ability to communicate effectively both orally and in writing, with the ability to exchange information on factual matters, as well as the ability to provide tact and empathy in difficult interpersonal situations.
• Candidates from New England region preferred.