Credentialing Specialist

    • Job Tracking ID: 512365-698463
    • Job Location: Petaluma , CA
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 04, 2019
    • Years of Experience: Less Than 1 Year
    • Starting Date: August 16, 2019
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Job Description:

Summary: The Credentialing Specialist is responsible for monitoring the verification process for medical staff at PHC. This includes obtaining and/or verifying required information for certified staff / providers necessary for compliance with our credentialing, re-credentialing and privileging process, and for maintaining the credentialing files and preserving their confidentiality. The Credentialing Specialist also coordinates other employment-related functions for providers, including the administration of the Provider Loan program and the tracking and updating of provider and Independent Contractor contracts and agreements.

The Credentialing Specialist works in collaboration with the Human Resources Department and hiring manager for newly hired staff, and collaborates extensively with the Compliance Officer, clinical staff members, the Medical Director, and Occupational Health staff.

Areas of Responsibility:

  • Overall coordination and administration of the credentialing process for certified staff and providers at PHC. This includes, but is not limited to, obtaining and/or verifying required information for certified staff / providers necessary for compliance with our credentialing, re-credentialing and privileging process
  • Administrative duties such as ensuring state medical licenses are up to date, checking statuses on new applications, running background checks on clinical applicants
  • Maintain credentialing and employment files for each provider and licensed medical professional
  • Develop a system to efficiently track credentialing activities so that PHC is continually in compliance with all applicable policies. This may include implementing and administering a credentialing software program
  • Coordinate with the provider scheduler for privileging and scheduling purposes
  • Partner with recruiting coordinator for on-boarding providers and medical staff: At the point of hire of licensed and credentialed clinical staff, will coordinate the information gathering process and review concerns with Human Resources and the Compliance Officer prior to presenting the file to the IRMC
  • Coordinating the re-credentialing process: Licensed and certified clinical staff are recredentialed for continuation of clinical privileges on a two-year cycle. Responsible for gathering the necessary information and submitting the information to the Compliance Officer for presentation to the Internal Risk Management Committee
  • Coordinate the Provider Loan Program, including the acquisition and tracking of all required documentation needed to support the application and eligibility of the provider recipients
  • Monitor and track all provider contracts, including Independent Contractors, to ensure their contracts are current and that renewals are communicated to their managers in a timely basis
  • Act as the HR point of contact for providers in the areas of contracts, loans, and credentialing needs and issues. Partner with the HR team for information or guidance order to effectively address the needs of the providers in these specific areas

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Movement within health center complex environment repeatedly throughout the day
  • Ability to write by hand, use phone, use computer keyboard and mouse extensively to perform general office functions
  • Manual wrist and finger dexterity and wrist-finger speed sufficient to perform repetitive actions for extended periods of time
  • Ability to effectively communicate by hearing continuously and speech in a manner which can be understood by a diverse population
  • Ability to give and follow verbal and written instructions with attention to detail and accuracy
  • Must have visual acuity near and far (20 inches to 20 feet), depth perception, field of vision, ability to focus on an object, ability to identify and distinguish colors
  • Ability to sit or stand for extended periods of time (minimum periods of one (1) hour at a time)
  • Ability to frequently walk, bend, squat, stoop, kneel, twist, crouch, and climb with the use of a step stool
  • Ability to grasp, hold and pick up and reach with hands and arms
  • Ability to frequently lift and or move up to fifteen (15) pounds
  • Ability to occasionally lift and carry up to thirty (30) pounds (periodic lifting of supplies or equipment)
  • Ability to coordinate multiple tasks simultaneously
  • Ability to travel to and from other health center sites and community locations

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

While performing the duties of this job, the employee is regularly exposed to general office and health center area environment with frequent interruptions by staff, visitors and phones. The work environment is a clean, well-lit, well-ventilated, and temperature controlled environment. The noise level in the work environment is usually moderate. The hours of duty are Monday through Friday during the business day. The employee must be willing to work varied hours to accommodate meetings and special functions.


Experience and Skills:

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education/Experience: * Bachelor's Degree preferred

Desired Skills:

  • Strong attention to detail
  • Ability to multi-task and manage multiple projects simultaneously

Language Skills: Ability to read, analyze and interpret common technical journals, financial reports and legal documents. Ability to communicate with customers, regulatory agencies or members of the business community.

Mathematical Skills: Ability to add, subtract, multiply, divide in all units of measure, using whole numbers, common fractions and decimals at the college level.

Reasoning Ability: Ability to recognize problems, collect data and establish facts.

Computer Skills: Knowledge of word processing and spreadsheet software, Human Resource systems and Database software. Proficient in Microsoft Word, Excel and Outlook.