Credentialing Specialist
Posted 3ds ago
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Job Description
Credentialing Specialist processing physician applications and maintaining medical staff databases for HonorHealth, an Arizona nonprofit healthcare system. Ensuring compliance with healthcare credentialing standards.
Responsibilities:
- Process initial credentialing and reappointment applications for medical staff and allied health applicants
- Provide credentialing support to the credentialing manager and centralized appointment/reappointment process
- Obtain required data from Quality Assurance profiles and National Practitioner Data Bank reports
- Secure peer competency references and prepare credentials files
- Obtain primary-source and other verifications
- Communicate with applicants to ensure timely completion of credentialing
- Research incidents, malpractice claims, advisory letters, and letters of concern and request follow-up information
- Maintain credentialing, physician, and departmental databases, including Midas
- Enter, update, and verify provider biographical and appointment data
- Prepare reports and maintain provider rosters and physician files
- Contact physician offices regarding meeting attendance, malpractice coverage, DEA certification, and related matters
- Notify database users of provider additions and changes
- Download information and conduct Internet searches for project work
- Maintain and update the hospital website Network Webpage Master
- Respond to Affiliation Letters in a timely manner
- Ensure physician documents do not expire
- Perform clerical, document preparation, filing, office administration, equipment maintenance, and supply procurement functions
Requirements:
- High School Diploma or GED required
- 1 year of credentialing, medical staff, or administrative assistant experience including data entry in a hospital or healthcare environment required
- Knowledge of medical terminology and professional physician interface
- 3 years in a credentials or medical staff services setting preferred
- College or professional coursework in medical terminology, health care, documentation, or law preferred
- Certified Provider Credentialing Specialist (CPCS) certification preferred
- Working knowledge of credentialing
- Ability to maintain confidentiality, data security, and accurate records
- Familiarity with Quality Assurance profiles, National Practitioner Data Bank reports, NCQA, The Joint Commission, DNV, Arizona Department of Health Services standards, and Midas database
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