Credentialing Specialist

The Credentialing Specialist will ensure that the credentialing process is carried out as efficiently and effectively as possible in compliance with the policy directives of the medical staff bylaws and to assure compliance with accreditation and regulatory requirements.

The Credentialing Specialist will be responsible for the creation, processing, and the maintenance of credentialing files.

Perform the following job-related duties and responsibilities :

• Distribute complete credentialing applications to medical staff requesting privileges at Rural Psychiatry Associates and other managed health care facilities as applicable
• Process all initial applications for Medical / Professional Staff appointments and privileges to meet company policies and procedures, Medical Staff Bylaws, and regulatory agencies standards
• Processes all Medical / Professional Staff reappointments according to policies and procedures, Medical Staff Bylaws, and regulatory agencies standards
• Process temporary privileges and one-case privileges according to policy and procedure and the Medical Staff Bylaws
• Prescreen applicants to ensure that the minimum criteria necessary for application to the facility are met
• Ensure medical staff applicant adheres to the proper time periods outlined in Medical Staff Bylaws
• Obtain all necessary documents to complete credentialing application
• Create and maintain credential files for each Medical / Professional staff privileged, assist with inspections by regulatory agencies and / or accreditation surveyors
• Verifies Staff licenses for initial appointment, reappointment, license renewal, and temporary privileges
• Submits complete credentialing materials to the Medical Director and flag any concerns for initial appointment and reappointment applications
• Verify consistency between the information submitted by the applicant and the information obtained from other sources
• Monitor time frames for each step of the credentialing process
• Monitor access to the credentialing files
• Query state agencies on licensure and disciplinary actions of all privileged staff on an ongoing basis
• Ensure state and federal regulations are met
• Maintain a current copy of Medical Staff Bylaws and rules and regulations
• Ensure the credentialing process proceeds according to Bylaws
• Coordinate the facility's continuing medical education (CME) functions and maintenance of the CME documentation
• Coordinate the credentials committee meetings with the responsibility of taking meeting minutes
• Query and report to the National Practitioner Data Bank (NPDB) and state licensing boards
• Update various forms and letters as approved by the credentials committee, medical staff and board
• Maintains an up-to-date physician database, including medical licenses, DEA certificates, professional liability insurance, and renewal period expirations dates
• Provide oversight, education, and training to medical staff as necessary
• Exhibits a high degree of responsibility for confidential matters
• Perform related duties as assigned
• Attend meetings as directed
• Management of third party insurance credentialing for Medical / Professional Staff to include Medicare, Medicaid, Blue Shield, and other payers as necessary
• Responsible for initial credentialing and re-credentialing processes.
• Responsible for assisting in the development and implementation of administrative policies and procedures related to credentialing and billing process which are directly related to credentialing.

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