Credentialing Specialist

The Medical Board Office at SUNY Downstate Health Sciences University is seeking a full-time TH Staff Assistant 2 / Credentialing Specialist.

Position Summary

The Credentialing Specialist will support the credentialing and privileging process for members of the medical staff and other practitioners. The position is responsible for distributing and processing applications, obtaining and reviewing primary source verifications, maintaining accurate credentialing records, preparing files for committee review, and supporting Medical Board and medical staff activities. The successful candidate will manage a substantial workload independently while maintaining accuracy, timely follow-up, confidentiality, and a high level of customer service.

Key Responsibilities & Duties

• Distribute applications for medical staff membership and/or clinical privileges.
• Process initial appointment and reappointment applications as assigned, with the goal of completing processing within 60 days and in accordance with applicable Medical Staff Bylaws, policies and procedures, and relevant accreditation, regulatory, and other requirements.
• Collect and analyze primary source verifications of credentials, education, and training; identify potential compliance concerns and initiate follow-up requests for additional information when necessary.
• Assemble and prepare credentialing files for review by the Medical Board Director, Clinical Department Chairperson/Chief, Credentials Committee, and Medical Executive Committee, as applicable.
• Perform accurate and timely data entry in the credentialing software and assist with credentialing database management.
• Track, monitor, and update expiring or expired credentials and related practitioner information to ensure that database records remain accurate and current and that required licenses and certifications remain valid.
• Maintain and apply a working knowledge of credentialing and privileging requirements, including applicable CMS standards, New York State laws and regulations relating to credentialing and medical staff organization, The Joint Commission standards, and National Committee for Quality Assurance (NCQA) standards.
• Coordinate and support meetings of the Credentials Committee, Medical Executive Committee, and/or Medical Staff. Coordinate post-meeting follow-up to ensure that actions are taken, referrals are made in a timely manner, and required notifications are completed.
• Assist in reviewing and preparing credentialing files and related documentation for managed care audits, site visits, and accreditation surveys.
• Process requests for verification of hospital affiliation (2805 letters) and provide responses within 45 days of receipt of the request.
• Provide administrative support to the Medical Board/Medical Staff Office, including answering telephone calls, reception, filing, scanning, audit preparation, and mailings.
• Assist with special projects and perform other related duties as assigned to meet departmental and/or system needs.

Required Qualifications

• High school diploma or equivalent.
• Ability to independently manage a large volume of work and meet established processing and response deadlines.
• Excellent oral and written communication skills.
• Excellent customer service skills.
• Strong attention to detail and commitment to maintaining accurate records.
• Or, a satisfactory equivalent combination of experience, education and training.

Preferred Qualifications

• Experience in hospital medical staff credentialing.
• Knowledge of the Cactus/Symplr credentialing database.

Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.