Job Summary:

The Credentialing Specialist is responsible for providing administrative support for the process of privileging and credentialing the medical staff at Westchester Medical Center. Performing primary source verification and ensuring that all physicians, residents, fellows, dentists, and allied health professionals are clinically qualified for the privileges applied for are major responsibilities of this position. Work is performed in compliance with detailed requirements, guidelines, and deadlines of Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Westchester County Health Care Corporation Board of Directors, accrediting organizations and regulatory agencies Does related work as required.

Responsibilities:

• Performs primary source verification of professional education, training and employment, clinical licensure, board certifications, Drug Enforcement Administration registration, infection control, and other relevant certificates.
• Queries National Practitioner Database and other relevant national databases and organizations, conducts reference checks and malpractice audit history.
• Requests documentation, follows up on receipt of required documents, reviews documentation, and updates status of application to completion.
• Supports medical staff committees in the application and credentialing.
• Develops and maintains an Excel database for tracking sensitive documents, and monitoring expiring licenses and communication of required approvals.
• Compiles statistical information and data on medical staff and allied health professionals.
• Responds to requests for practitioner information regarding privileges.
• Participates in monthly committee meetings and training sessions for clinical department administrators.
• Supervision over a number of clerical and office support staff.

Experience:

5 years of experience where the primary function of the position was medical staff credentialing, required.

Education:

High school or equivalency diploma, required. Satisfactory completion of 30 college credits* may be substituted on a year for year basis for up to four years of the above experience. Education beyond the secondary level must be from an institution recognized or accredited by the Board of Regents of the New York State Education Department as a post-secondary, degree-granting institution.

Licenses / Certifications:

Other:

Good knowledge of medical staff credentialing processes, procedures and resources; good knowledge of requirements of various organizations which affect the credentialing process such as CMS, NCQA, NYS Education Department, and NYS Department of Health; good knowledge of the requirements of Westchester Medical Center Bylaws and policies regarding credentialing and privileging standards for the various clinical departments and sections; good knowledge of medical terminology; ability to assemble and organize data; ability to determine priorities and meet deadlines; ability to effectively use computer applications such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to communicate effectively both orally and in writing; ability to establish and maintain effective working relationships with professional medical, technical, managerial, clerical and unskilled personnel; attention to detail; sound and mature judgment; flexibility; resourcefulness; initiative; tact; physical condition commensurate with the demands of the position.

About Us:

NorthEast Provider Solutions Inc.