Credentialing Specialist - Somerset, NJ

Job Overview :

The Credentialing Specialist is accountable for performing duties related to the sending, receiving, processing, and primary source verifying applications for initial and reappointment and their related clinical privileges.

Exemplifies a culture of excellence, effective communication and collaboration, and customer service with central Medical Staff Office (MSO) leadership and staff, internal and external customers, providers, and clinical and administrative leaders within RWJBarnabas Health.

Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential.

Possesses and develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to collaborates with local Medical Staff Offices to facilitate timely completion of credentialing processing.

Works to develop an overall singular culture of excellence and efficiency across the enterprise.

Qualifications : Required :

Required :

• Associates degree or combination of education and experience deemed equivalent
• Successful completion of all RWJBarnabas Health orientation programs

Preferred :

• At least two (2) years of experience CVO or Medical Staff Services in an acute healthcare setting, including credentialing and privileging
• Certified Professional in Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred
• Knowledge of credentialing software and associated applications strongly preferred
• Excellent interpersonal and communication skills
• Ability to work under minimal supervision and to adapt quickly to changes within the environment

Scheduling Requirements :

Fully onsite- Somerset, NJ

Essential Functions :

• Oversees and assists with application management and verification activities, preliminary analysis of application and verification information
• Analyze verification information, to include identifying red flag and / or adverse information and notifying central MSO leadership in accordance with policies
• Oversee the monitoring of expiring information such as but not limited to DEA, license, professional liability insurance, and specialty board certification status;

maintain and update credentials file(s)

• Management of database entries for accuracy and completeness
• Maintenance of electronic files as required
• Effective and timely communication with local medical staff offices
• Timely and accurately prepare credential files for audit and submission to the hospitals
• Monitor staff productivity in accordance with standard turn-around-times
• Maintain a working knowledge of relevant regulatory standards (i.e., TJC, DNV and NCQA), state and federal requirements, and applicable Medical Staff Bylaws
• Assist with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes
• Assist in the development or revision of credentialing related forms
• Participation in special project teams as assigned
• Training of new staff as assigned - credentialing procedures, software, and workflows
• Enforcement of internal procedures and controls and problem resolution
• Takes a proactive role in monitoring and assisting in improving team productivity
• Continually strives to achieve individual, team and departmental goals
• All other duties as assigned

Other Duties :

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities and activities may change at any time with or without notice.