Credentialing Specialist

 

CREDENTIALING SPECIALIST

Provider Network Development and Credentialing

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Wexford Health Sources, one of the nation's leading innovative correctional health care companies, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality.  For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.

At Wexford Health our philosophy is that health care should not be considered a luxury for anyone.  We simply care for those in need and the corrections environment is our venue.

 

POSITION: Credentialing Specialist

DEPARTMENT: Provider Network Development and Credentialing

LOCATION: Pittsburgh Office

 

POSITION SUMMARY

The Credentialing Specialist conducts and facilitates, on an ongoing basis, the credentialing of all professional employed staff and contracted providers to include initial appointments, reappointments and the maintenance of documents and files.  The Credentialing Specialist also provides administrative and secretarial support to the Credentials Committee.

RELATIONSHIPS: Works effectively with the Wexford companies’ medical staff, Wexford companies’ Regional and Corporate staff, and outside agencies and hospital personnel. 

 

DUTIES/RESPONSIBILITIES

  • Deal professional with confidential information.
  • Process professional staff appointments/reappointments which includes but is not limited to obtaining copies of all current documents, entering physician data into the Credentialing database, send/track/follow-up on primary source verification letters, and copying files to be sent to facilities.
  • Process professional network providers appointments/reappointments which includes but is not limited to obtaining copies of all current documents, entering physician data into the Credentialing database, send/track/follow-up on primary source verification letters, and copying files to be sent to facilities.
  • Process all new applications and obtain primary source verification of education, training, licensure, certification, sanctions and primary hospital affiliation.
  • Verify licenses and run NPDB reports on candidates.
  • Run and review AMA reports on candidates.
  • Work closely with provider contract specialists and recruiting to credential candidates in a timely and efficient manner.
  • Interact professionally and support all levels of staff in corporate and regional locations.
  • Create, maintain and ensure continuous review and updates of electronic and paper credentials files.
  • Generate expired document and reappointment reports, and other credentialing database reports, as needed.
  • Assist with follow-up and tracking of expired and delinquent documents to include but not limited to licenses, certifications and malpractice insurance.
  • Prepare credentialing status report for biweekly team meetings.
  • Follow-up per credentialing policies and procedures during appointment/reappointment process and when notified of possible lawsuits or credentials issues.
  • Provide credentialing information to Wexford companies’ facility and regional staff for audits, meetings, inspections, etc., as needed.
  • Maintain logs and key information in databases as necessary for data collection and tracking purposes.
  • Assist Chief Medical Officer, Regional Medical Directors and UM Physicians with obtaining/processing new medical license applications, as needed.
  • File and track physician peer reviews.
  • Prepare all documents and files for monthly Credentials Committee meetings to include but not limited to agendas, meeting packets and appointment/reappointment memos.
  • Record and transcribe Credentials Committee meeting minutes.
  • Prepare correspondence from Credentials Committee meeting, as needed.
  • E-mail notification of Credentials Committee actions to appropriate departments and administrators.
  • Prepare and reconcile credentialing fees report.
  • Perform department related research.
  • Perform research related to RFP development, as needed.
  • Assist with drafting and revising policies related to the credentialing process.
  • Maintain awareness of current operational procedures and standards that impact position responsibilities.
  • Assist with projects, report preparation and other department functions as requested or assigned.
  • Assume other duties as assigned and directed. 

The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.

 

PHYSICAL DEMANDS

The physical demands that are described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk, to hear and to see, to stand, walk, and sit, use hands to finger, handle or feel objects, instruments or controls, to reach with hands and arms, to stoop or crouch, balance and kneel, may be required to lift and/or move objects. Must be able to ambulate throughout the facility for extended periods of time. Specific vision abilities required by this job include close vision and distant vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.  Must be able to clearly communicate orally and via written and typed correspondence and notes using various forms, records, charts, and electronic media.

 

ENVIRONMENTAL CONDITIONS

OFFICE: Standard office environment in a Corporate office setting which includes daily interfacing with administrative departments and health care personnel.

TRAVEL: None

 

EDUCATION/EXPERIENCE REQUIREMENTS

The following requirements list the minimum to qualify.  An equivalent combination of education and experience may be accepted.

LICENSING: None

CERTIFICATION: None required

EDUCATION: High School Diploma or equivilant

PREFERRED EXPERIENCE: At least one (1) year experience in a Credentialing department or Administrative Assistant experience in a medical staff office required. 

OTHER:

  • Requires a comprehensive understanding of the credentialing process.
  • Ability to work effectively with physicians and other health care providers.
  • Strong interpersonal, and verbal and written communication skills
  • Excellent problem solving skills and strong organizational skills
  • Ability to develop and deliver presentations, and facilitate meetings
  • Must possess critical thinking skills and the ability to create processes
  • Must be highly organized and detail-oriented; capable of performing under a variety of requirements and deadlines.
  • Must have strong computer skills (Microsoft Office), as well as the ability to research information on the internet.