Credentialing Specialist
US-NM-Ruidoso
Careers (External)
Req #: 47819
Type: Part-Time1
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Overview: Summary: Conducts thorough background investigation on physicians and other providers applying for affiliation with PHS -Albuquerque and regional facilities. This includes reviewing applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence. Identifies issues that require additional investigation and/or follow-up. Responsible for collecting and processing reappointments of Medical Staff members and ensuring they are completed within specified time periods. Processes requests for updated privileges, status changes. Maintains a variety of tickler systems to ensure that processing is timely and meets state and federal regulatory requirements and accreditation standards as they apply to Credentialing. Maintains accurate data in the credentialing database which is accessed by multiple business units within the organization Type of Opportunity: Part Time (.45 to .89) FTE: 0.500000 Exempt: No Work Schedule: Days Responsibilities: Responsibilities: *Analyze practitioner applications and/or requests to ensure that required documentation/information has been submitted in order to initiate the primary source verification processes *Conducts primary source verification of applicants' education, licensure, professional work history, medical malpractice history for the purpose of determining competency and eligibility to be awarded membership and/or privileges *Prepares processed files for review by appropriate members of medical staff leadership, including identification of information that may require additional investigation *Utilizes appropriate tracking tools for the purpose of ensuring timely completion of applications *Collects/analyzes data from various sources to include with initial and/or reappointment applications. Such data includes but is not limited to focused professional practice evaluations, ongoing professional practice evaluations, and privileging eligibility criteria *Process other credentialing requests, as assigned, in accordance with established policies and procedures *Responsible for on-boarding and/or orientation of new Medical Staff members, according to established policies and procedures Qualifications: Other information: High School Diploma. One to three years experience in hospital medical staff or managed care credentialing preferred. Certification or eligibility for certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred. Education: Essential: * High School Diploma or GED
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