Credentialing and Licensing Specialist

The Credentialing and Licensing Specialist supports the Credentialing and Licensing department and works closely with many health-care facilities and agencies, educational institutions, state agencies, etc. to verify a provider’s credentials and experience. They do this by ensuring all expirables in the provider’s file are obtained and updated timely, all submitted CME is saved in the provider files and entered in credentialing database, currently Modio, and performs other tasks that support the internal credentialing and licensing processes. The specialist is responsible for ensuring compliance with The Joint Commission credentialing standards as well as state licensing agencies and facility client credentialing/privileging requirements.

• Participate in credentialing, re-credentialing, licensing, and privileging activities
• Assist and serve as a delegate for the providers
• Assist our business partner Virtual Medical Staff, VMS with ongoing credentialing and re-credential for the Sevaro providers.
• Sends out initial physician applications
• Communicate with physicians regarding onboarding, credentialing, or reappointment documentation needed
• Obtain required documents, reviews applications, prepares verification letters and utilizes the company’s credential software program, currently Modio.
• Obtain License, Employment and Insurance Verifications, and Peer Reviews in accordance with Joint Commission standards for all new physician hires
• Query Sanctions check, NPI Registry, AMA, & NPDB and other databases for all new physician
  hires
• Add new hires to credentialing database and update credentialing database and provider’s file with current and accurate information
• Process Primary Source Verification as part of the credentialing process
• Contact medical staff offices, licensing and government agencies to complete credentialing and re-credentialing applications.
• Collect all required credentialing documents listed on checklist i.e. (medical degrees & training certificates, board certification, DEA, ECFMG, identification, license copies, CMEs, etc.)
• Ensure work and product standards are of the highest quality
• Maintain professional communication with all external customers, coworkers, and management
• Maintain compliance with Joint Commission Credentialling Standards
  Maintain strict confidentiality of all provider files
• Place equipment request for onboarding physician at the appropriate time during onboarding process
• Communicate any flags or concerns

LICENSING RESPONSIBILITIES:

• Assist in the oversight of the processing of licensing applications for MD’s and DO’s to meet internal deadlines.
• Collect, organize, track, and manage items requested by state boards, for multiple providers. Including, but not limited to, fingerprint cards/background checks, CE Courses, peer references, transcripts, supervision request, license verifications, employment affiliations, notarized forms, photos, Board certification, etc.
• Perform follow-up with various state licensing Boards to obtain application status
• Scanning, faxing, mailing, and populating multiple forms and documents
• Create access for online state licensing web portals for application submission
• Populate state medical license applications via web portals and/or paper applications as required for each board
• Build and maintain business relationships with providers who are engaged in the licensing process
• Build and maintain business relationships with the licensing contacts at each state medical board
• Develop a system for managing state-by-state continuing education requirements and ensuring practitioner compliance in Credentialing software
• Research state licensing requirements, as needed
• Manage and track licensing

QUALIFICATIONS:

• Prior credentialing and licensing experience preferred.
• Three (3) + years experience in the healthcare field preferred.
• Attention to detail.
• High degree of confidentiality, accuracy and organizational skills are required when dealing wit information that this position is responsible for.
• Strong communication and interpersonal skills to deal with a wide variety of personalities required.
• Ability to work in fast-paced environment and maintain a sense of urgency.