Job Description

Job Title: Credentialing Specialist

Department: Medical Staff

Reports To: Director, Medical Staff

Job Summary:

Coordinates and directs medical staff activities in consultation with Vice President of Medical Affairs, Medical Center President/CEO. Applies general understanding and specific procedures and policies through independent judgment. Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies. Supports departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and source verifications. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility.

Job Responsibilities include:

1. Assist with hiring new staff by reviewing resumes and applications to ensure that applicants fulfill all necessary licensing and credential requirements and eligibility for membership/participation.
2. Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information.

1. Conducts, participates in, and maintains primary source verification.
2. Verify that the professional training, certifications and licensing of healthcare professionals, which need to be renewed periodically, are up to date and in compliance with state and federal regulations.
3. Performs background checks, contact licensing boards, review license applications, request education details and interview references.
4. Conducts, participates in, and maintains current clinical competency evaluations and peer review.

1. Organizes information and data to identify/explain trends, problems, and their causes. Compares, contrasts, and combines information to determine underlying issues. Sees associations between seemingly independent problems or events to recognize trends, problems, and possible cause-effect relationships.

1. Compiles, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies.

1. Maintains databases for medical professionals and healthcare facilities
2. Performs initial, reappointment/re-credentialing for eligible practitioners as well as processing of privilege and membership modification requests.
3. Manages compliance with accreditation standards and regulatory requirements.
4. Complies with accreditation and regulatory standards.
5. Facilitate medical staff functions (Orientation, Training, maintaining current provider credentialing files).

• Is flexible in assuming other appropriate responsibilities not noted above.

Requirements:

Education - Associates Degree or H.S. Diploma with minimum of 5 years directly related experience. CPCS certification preferred.

In lieu of the above education requirement previous work history and years of experience and certification may/will be considered.

Experience -

• Five years of Medical Staff Office and Credentialing experience.
• Strong oral and written communication skills.
• Working knowledge of software applications including Microsoft Word, Excel, and PowerPoint.
• Ability to handle sensitive information with absolute confidentiality.
• Organizes work, effectively prioritizes, and sets short- or long-term goals and strategies to achieve them. Aligns communication, people, processes, and resources to drive success.

• Understands clinical competence evaluation concepts, key functions and terminology,
• Knowledge and understanding of Cayuga Health System medical staff, Medical Bylaws, Joint Commission Regulations, NYS Regulations, NCQA and CMS Regulations.

Licensure - N/A

Physical Requirements - The ability to lift 25 pounds.

Cayuga Health System Commitment to Diversity, Equity & Inclusion

Cayuga Health System commits to treat all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.