Credentialing Specialist - FT - Days Rotation
$44,137,600–$53,164,800 year
On-siteElmira, New York, United States
Job Summary
Review applications and credentials to verify licensing, certification, and membership eligibility requirements. Analyze credentialing and privileging applications for completeness and accuracy, communicating with practitioners regarding outstanding documentation. Conduct primary source verification for all required elements in accordance with NCQA, CMS, Joint Commission, and internal policy standards. Perform initial credentialing, reappointment, and re-credentialing activities, including processing privilege and membership modifications. Coordinate and maintain ongoing professional practice evaluations and peer review activities to support credentialing decisions. Compile and interpret practitioner-specific data for review by the Medical Executive Committee. Maintain and update credentialing databases within systems such as MDStaff to ensure data integrity. Apply analytical skills to identify trends and recommend process improvements. This role supports departmental operations to uphold quality and patient safety standards within a sedentary environment requiring extended computer work.
Required Qualifications
- Associate's Degree or High School Diploma
- minimum of five (5) years of directly related medical staff or credentialing experience
- Primarily a sedentary work environment requiring extended periods of computer and desk work
- ability to effectively operate standard office equipment
- ability to communicate with staff, providers, and external agencies
Desired Qualifications
- CPCS certification preferred (or commitment to obtain certification within an established timeframe)
- Minimum of five (5) years of experience in a Medical Staff Services or Credentialing environment
- Strong oral and written communication skills with the ability to interact professionally with practitioners, leadership, and regulatory bodies
- Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint
- Demonstrated ability to manage confidential information with a high level of integrity and discretion
- Excellent organizational skills with the ability to prioritize work, manage multiple deadlines, and set short- and long-term goals aligned with departmental objectives
- Working knowledge of clinical competence evaluation processes, medical staff bylaws, and regulatory standards, including Joint Commission, NYS, NCQA, and CMS requirements
- Familiarity with MDStaff credentialing software, and multi-hospital system environments
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.