University of Rochester Credentials Vertification Specialist in Rochester, New York

Opening

Full Time 40 hours Grade 009 URMC Medical Staff Services

Schedule

8:30 AM-5 PM

Responsibilities

Position Summary:

The Credentials Verification Specialist (CVS) serves as a Medical Staff Services Professional (MSPs) dedicated to thoroughly investigating and verifying the credentials of healthcare practitioners to ensure the quality and competency of the practitioners.

The CVS is dedicated to making certain that all patients receive care from practitioners of the health care organization are properly educated, licensed and trained in their specialty. This process involves a detailed and systematic level of work commonly known as privileging and credentialing. It includes the collection and gathering of documents and information for processing the credentialing files of initial appointment and re-appointment applicants.

The CVS ensures compliance with regulatory bodies including but not limited to, The Joint Commission, NCQA, CMS, Federal and State, applicable Medical Staff Bylaws, Rules and Regulations, Policies and Procedures, and delegated contracts and/or other contracts as applicable. The CVS is also responsible for the accuracy and integrity of the credentialing database system and related applications.

Responsibilities:

  • Coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  • Conducts thorough background investigation, research and primary source verification of all components of the application file.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Communicates the status of the files directly to providers and various department representatives and/or outside organizations, clients or affiliates and coordinates efforts to obtain necessary information and/or documentation to assure deadlines are met.
  • Prepares credentials file for completion and presentation to Health System Entity Medical Staff Committees, ensuring file completion within time periods specified.
  • Processes requests for privileges when applicable, ensuring compliance with criteria outlined in clinical privilege descriptions.
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
  • Utilizes the MSOW credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act when applicable.
  • Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, other Health Professional staff, and delegated providers.
  • Performs miscellaneous job-related duties as assigned.

Qualifications:

Two years post high school education in administrative studies or equivalent. Certification by the National Association for Medical Staff Services (NAMSS) a plus. At least three years of secretarial and/or office experience and/or at least one year experience in health care/health plan credentialing. Experience with Microsoft Office applications required. Experience with database applications preferred. Experience in credentialing and regulatory requirements and accreditation preferred. Candidate must be flexible and work well in a team environment. Ability to work in a fast paced environment and multi-task and demonstrated skills related to achievement of customer satisfaction.

EOE Minorities/Females/Protected Veterans/Disabled

Job Title: Credentials Vertification Specialist

Location: Medical Faculty Group

Job ID: 202011

Regular/Temporary: Regular

Full/Part Time: Full-Time