Credentialing Specialist - TEKsystems

Description:

Monday - Friday Flexible hours between 7am - 9am start time- 40 hours a week. Must be local to Detroit to be able to pick up the equipment and do orientation at

Under general supervision, responsible for all functions relating to the credentialing and re-credentialing of practitioner applicants. Responsibilities include data entry, data collection, and verification of credentials from primary source and analyzes information collected for presentation to medical staff leadership.

Responsible for verifications for medical staff and allied health professionals' initial appointments, provisional reviews, reappointments, and privilege delineation;

a. Coordinates the processing of applications. Assure all applications are processed completely and in a timely manner;

b. Verifies required primary source credentialing documentation to ensure medical staff and allied health professional files are current and policies and procedures have been followed to obtain required documentation and verification;

c. Coordinates activities and explains procedure to facilitate the reappointment process;

d. Request confidential information such as case logs, procedures and other sensitive matters;

e. Tracks responses and follows-up on items not received within established time frames;

Maintains credentialing software database by ensuring that data entered is complete and accurate;

Submit completed files to MSO offices and delegated entities;

Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information;

Assist in compliance with the accrediting and regulatory agencies (i.e. The Joint Commission, NCQA, URAC, HFAP) in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws;

Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the CCS by participating in professional organizations, attending seminars and reading journals and publications addressing medical staff services activities and trends;

Participates in system integration and continuing quality improvement efforts;

Receives, evaluates and answers customer inquiries and provides customer support in accordance with corporate standards of excellence;

Performs other duties as required which are subject to change at the discretion of management.

Additional Skills & Qualifications:

2+ Years of Prime Source Credentialing Experience - Required

MUST have 1+ Years of Hospital Credentialing Experience (outpatient/clinic experience does not apply)- Required

MUST be proficient with using MDStaff Credentialing Software - Required

End-to-end provider Credentialing Experience (MDs & DOs) - Required

Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and all applicable standards.

Must be able to work independently in a fast-paced environment

Can be onsite or remote (must live near Detroit - will be required to pick up equipment and briefly orient onsite)

Must be able to work full-time hours

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.