Corporate Credentialing Specialist

Company Overview: #LI-Remote Shriners Children’s is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families. All employees are eligible for medical, dental and vision coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403(b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a full-time or part-time status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans. Additional benefits available to full-time and part-time employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law. Job Overview: The Corporate Credentialing Specialist coordinates and organizes ongoing credentialing and privileging of physicians and advanced practice professionals. Responsible for review, analysis and follow up of credentialing and privileging applications, maintaining strict confidentiality. Ensures compliance with federal and state agencies, organizational policies and accrediting and regulatory agencies. Responsibilities: • Coordinates and organizes credentialing/privileging requests/modifications for an SHC facility and supports providers requesting privileges at affiliate locations. Ensures evidence of education, training, and experience to determine eligibility for requested privileges, membership. • Verifies and documents credentials and expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards; as well as manages and documents all communication with providers and primary facilities to ensure notification of upcoming expirables. Keeps record of all credentialing activities in the credentialing database to ensure files reflect current status. • Recognizes, investigates, and validates discrepancies and adverse information obtained; obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance. • Responsible for confidentiality and data entry, maintenance, and analysis of clinical provider information within database per established guidelines to ensure complete electronic credential file to support provider enrollment and delegation requirements. • Collaborates credentialing, OPPE, FPPE and privileging activities with SHC Medical Staff Offices to ensure timely approval process of governing bodies, participation in accreditation surveys and audits, to include verification of appropriate drug and criminal background screenings. Prioritizes workload to meet deadlines. • Maintains current knowledge of accreditation standards (TJC, NCQA), state and federal regulations, as well as SHC medical staff bylaws, regulations, and procedural rules. This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned. Qualifications: Minimum: • 1 year of hospital regulatory credentialing experience • 1 year of experience maintaining all required data in MD Staff, or similar credentialing database • Proficiency in MS Office required (Word, Excel, PowerPoint, Outlook, Access) • CPCS or CPMSM certification - if not currently certified, will need to obtain within 24 months of hire or upon eligibility • High School Diploma or GED required Preferred: • Associate's or Bachelor's Degree Apply Job!