Credentialing Specialist (15018)

Northern Light Health
Job Description

Northern Light Health 

Department: Credentialing

Position is located: Douglas Brown Building, Bangor

Work Type: Full Time \ 40 Hours per Week \ 8:00am to 4:30pm

To Apply Click:  Credentialing Specialist

For More Information:  Text "15018" to (207) 506-0033


The CVO Credentialing Specialist is responsible for credentialing and re-credentialing providers within the Northern Light Health System. Credentialing functions include, but are not limited to, processing credentialing/re-credentialing applications, performing primary source verification and updating and maintaining the credentialing database in accordance with internal policies and procedures and applicable Federal and State regulatory standards. Effectively builds positive, quality-enhancing relationships between the Medical Staff Services Department and the Centralized Credentialing and Verification Office (CPDM).

Education and Experience:

  1. Associate degree required with 1-2 years' experience that is related to the duties and responsibilities as specified. In some cases, Northern Light Health will consider years of experience as a substitute for educational requirements in accordance with Northern Light Health’s Education Experience Equivalence policy.
  2. Pursuing NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM) required.
  3. Professional Association: Affiliation and participation with the National Association Medical Staff Services and the Maine Association Medical Staff Services is strongly encouraged.

Regulatory Requirements: Working knowledge of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards. State/federal/licensure regulations, particularly as it relates to the credentialing of physicians and advanced practice professionals.

Required Minimum Knowledge, Skills and Abilities

•Ensure confidentiality, security and integrity of data and information within areas of responsibility.

•Demonstrated ability to work under pressure and toward strict deadlines while concurrently keeping track of multiple processes in multiple stages of completion while adaptable to growth and change.

• Ability to research and analyze documents utilizing strong documentation skills with high attention to detail.

•Advanced computer skills and strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products and ECHO credentialing software preferred.

•Ability to use critical thinking skills to conduct follow-up with group organizations, internal and external entities to resolve discrepancies identified during the credentialing process.

•Exceptional oral and written communication skills are also essential, confident phone skills and client interactions as this position spends a great deal of time communicating with doctors, healthcare administrators, higher education institutions and government officials.

•Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.

• General understanding of related accreditation and certification requirements.

• General understanding of medical credentialing and privileging procedures and standards.

•General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

•Actively participate in team meetings and process improvement initiatives to continuously improve work productivity, quality and efficiency.

•Keep Manager informed of potential credentialing and/or verification issues.

• Demonstrates System values and integrates them into daily organization practice.

• Must have a desire to pursue individual professional development and performance management skills.

Supervision Received (ability to act independently)

•Receives general supervision and has ability to act independently to achieve established goals, consulting with management as appropriate.

•Reports to the Credentialing Manager. Must be an organized "self-starter" requiring little supervision in order to focus on and accomplish tasks.

• Supports the Quality and Education Specialist as assigned.

Essential Functions:

•Perform medical credentialing file/element investigation and primary source verification of provider’s initial and re-credentialing applications, utilizing established Standards, Client specifications and federal and state regulatory requirements. Ensure timely compilation of applicant and verification elements to prevent any negative outcomes or delays in the processing of applications/files.

•Uniformly apply clearly defined credentialing processes to all practitioners/providers.

•Maintain timely communication with applicants and member organizations on the status of the application files and any required documents or information needed to complete the medical credentialing process.

• Effectively conduct thorough investigation and compilation of the provider/applicant’s medical credentialing applications to assure compliance with System requirements and standards.

•Obtains and evaluates practitioner sanctions, complaints and adverse data to ensure compliance and alerts Manager of any undisclosed negative findings immediately.

•Analyze and maintains provider data entered in the ECHO database to ensure accuracy for Client Rosters, Third-Party Portal, National Practitioner Data Bank and Provider Finder.

•Independently 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.

•Identify administrative and professional issues with applications that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up with applicant, and Clients.

•Participate and support with suggestions for the development and improvement of workflow, client support and compliance goals to advance the quality of practitioners and patient safety to the System.

• Maintain knowledge of current regulatory requirements for medical credentialing.

•Performs miscellaneous job-related duties as assigned.

Physical Demands:

• Busy office environment, requiring the ability to frequently respond to unpredictable situations. Time may be spent sitting at a computer, collaborating with other healthcare team members.

• Extended periods of sitting, with option to stand at computer.

• Work requires repetitive motions of wrist, hands and fingers.

• Extended use of telephone.

• The ability to reach and stretch intermittently.

• Moderate walking throughout the facility.

• Tolerance for frequent interruptions

• Flexibility, dexterity, visual acuity, hearing acuity.

• Must be able to speak and communicate clearly and effectively.

• Must be able to adapt to frequently changing work priorities.

• Must be able to travel to various NLH/non-NLH sites as there will be occasional travel for off-site meetings, education and/or conference(s).

*Note: the duties listed above reflect the majority of the essential duties of this job and does not, nor is it intended to, reflect all essential duties that may be required for an incumbent in this job to perform.

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