Credentialing Specialist II - Medical Staff Services - Days - FT

The Memorial Credentialing Specialist II conducts and maintains physician credentialing, privileging, and primary source verifications for initial and reappointments to the medical staff. The specialist maintains credentialing data and information systems to facilitate department processes. The specialist ensures standards and regulatory requirement are upheld to ensure organizational compliance.

• Coordinates credentialing and privileging process for providers
• Assesses applicant initial eligibility for membership/participation
• Compiles and distributes required provider documentation for review to decision-making bodies
• Analyzes application and supporting documents for accuracy, completeness, and integrity
• Processes requests for privileges
• Coordinates provider onboarding procedures
• Conducts and maintains primary source verification
• Provides support for Medical Staff Services department meetings and special projects
• Maintains credentialing database to ensure that accurate and current information is updated on all providers
• Maintains practitioner/provider credentialing processes and information systems by analyzing the needs and resources of medical staff services/credentialing
• Coordinates and prepares agenda and minutes for Medical Staff specialty department meetings
• Participates and maintains compliance with accreditation standards and regulatory requirements
• Facilitates efficient and cost-effective due process that complies with an organization’s fair hearing and appeals policy as well as applicable legal and regulatory requirements
• Identifies and reports adverse actions taken against Provider in accordance with applicable law and contractual requirements
• Monitors and reports sanctions and complaints for all Providers to recommend action by medical staff and organizational leadership

Education

• High School or GED

License or Certification Required

• Certified Provider Credentialing Specialist (CPCS)

Experience

• 2 years of credentialing experience in a hospital medical staff services setting

Skills

• Basic Microsoft Excel skills
• Strong verbal and written communication skills
• Data entry with minimal errors
• Seeking solutions using appropriate methodologies