Credentialing Specialist — Clinical Operations

Primary Function/General Purpose of Position

The Credentialing Specialist facilitates Credentials Verification Organization (CVO) provider application and data collection, application processing and Primary Source Verification (PSV) for the organization. Supports the organization's on-boarding and off boarding processes. This role follows established standard operating procedures and market specific medical staff bylaws and demonstrates exceptional customer service, communication, reliability and commitment to quality.

Essential Job Functions

• Follows a standardized comprehensive credentialing application and data collection, application processing, and primary source verification processes that comply with all applicable regulatory standards.

• Executes credentialing application and data collection, application processing, primary source verification for all new applicants and applicants for re-credentialing. Assures applications are correct, complete, resolves discrepancies in compliance with all applicable regulatory standards.

• Assures files and documents are ready for Medical Director review, including all Credential Committees and Medical Staff Office (MSO). Works with the credentialing auditors to correct any deficiencies. 

• Organizes and maintains provider data and files. Processes applications timely and ensures that quality benchmarks are met with regards to turnaround times, accuracy of information and other CVO and regulatory metrics. 

• Assures that provider database is maintained with new and updated accurate provider information. 

• Follows all regulatory requirements related to the primary source verification process for medical staff and managed care compliance.

• Completes credentialing compliance check points to assure that files are ready for release. 

• Maintains awareness of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Center for Medicare/Medicaid (CMS) and other regulatory compliance guidelines through the organization's CVO provided continuing education.

• Demonstrates excellent professional communication skills while interacting with colleagues, customer relations and MSO representatives, and leadership to collect missing information or resolve issues.

• Maintains a strong respect for privacy and confidentiality. 

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services (NAMSS) (preferred)

Education

High School or GED (required)

Bachelor's Degree in Business, Healthcare or other related field (preferred)

Master's Degree in Business, Healthcare or other related field (preferred)

Work Experience

1 year recent experience in medical staff services or CVO setting (preferred)

Training

CredentialStream Credentialing software (STRONGLY preferred)

Language

None

As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected]