Credentialing Specialist
Department: Community Health & Research Center
Location: Dearborn, MI
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Job Title: Credentialing Specialist
Job Status: Full-time
Job Summary: Under general supervision, the Credentialing Specialist will play a critical role in supporting the Community Health & Research Center fee for service environment, the billing division, and contributing to patient safety and satisfaction. This role is responsible for ensuring that healthcare professionals and facilities maintain appropriate credentials and meet all regulatory and organizational standards in ensuring that physicians and other healthcare providers meet all necessary qualifications and standards. This role manages the credentialing process to support the delivery of quality healthcare services and maintaining the integrity and quality of healthcare expertise.
Essential Duties and Responsibilities:
Verify the credentials, licensure, certifications, and qualifications of medical and healthcare professionals, and ensure compliance with relevant regulations and industry standards
Conduct thorough checks of educational background, training, licensure, certification, and work experience of healthcare providers and ensure the accuracy of completeness
Maintain records of all credentialing activities, including updated information on licenses, certifications, and malpractice insurance
Ensure that all healthcare providers comply with state and federal regulations, as well as industry standards and organizational policies
Oversee the re-credentialing process for all health care providers and ensure timely renewal of credentials and certifications, avoiding any lapse in compliance
Verify the accuracy of health care provider information, including education, training, experience, and licensure
Maintain and update credential files and databases, warranting compliance with current regulations and standards
Communicate with healthcare providers, regulatory agencies, and other stakeholders to resolve credentialing issues
Coordination between healthcare providers, insurance companies, and regulatory agencies, facilitating timely and accurate exchange of information
Prepare and present credential reports to management and relevant committees
Assist in preparing for internal and external audits, providing necessary documentation and information to auditors
Stay informed about changes in healthcare regulations and credentialing requirements
Operate standard office equipment and use required software applications
Perform other duties and responsibilities as assigned
Knowledge, Skills, and Abilities:
Knowledge of:
Credentialing regulations, policies, and procedures
Relevant state and federal regulations, as well as standards set by accrediting bodies such as The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA)
Healthcare regulations and compliance standards
Proficiency in credentialing software and databases, as well as standard office applications
Skill in:
Strong attention to detail and organizational skills
Excellent written and verbal communications and interpersonal skills
Excellent organizational skills to manage multiple tasks and deadlines effectively
Operating standard office equipment and using required software applications for program area and other applications, including Microsoft Office
Ability to:
Manage multiple deadlines
Mutti task and able to negotiate and coordinate between multiple entitles in order to solve a issues
Be patient, self-control and provide a solution to issues
Build positive relationships with healthcare providers
Demonstrate a high degree of trust and confidentiality
Work independently
Educational/Previous Experience Requirements:
Minimum Degree Required:
o Bachelor-s degree
Required Disciplines:
o Healthcare Administration, Business Administration, or a related field
~and~
3 to 5 years- experience or any equivalent combination of experience, education and/or training approved by Human Resources
Licenses/Certifications:
Licenses/Certifications Required at Date of Hire:
o (CPCS), Certified Provider Credentialing Specialist is strongly preferred
Working Conditions:
Hours: Normal business hours, some additional hours may be required
Travel Required: None generally required; Local, in-state, national, and international travel, up to 10%
Working Environment: Climate controlled office
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