Job Description

Administrative/ Clerical


Phys Office Risk Management

Req Number:

Job Details:


Under the direction of the Senior Director of Credentialing Verification Office with daily activities supervised by the Credentialing Manager, this position performs all duties for initial and recredentialing file processing per NCQA, The Joint Commission, state and federal regulations and Medical Staff By-Laws.


Responsibilities include, but are not limited to:
* Coordinates the credentialing and recredentialing process for assigned practitioners.
* Collects and maintains all pertinent information from the provider. Communicates consistently with practitioners and provider office staff in a timely and effective manner to follow up to obtain required documents on a timely basis in alignment with processing guidelines.
* Verifies all credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage through a variety of primary sources as appropriate per NCQA and The Joint Commission standards. Researches incidents, malpractice claims, and appropriate follow-up information from practitioner or other sources as indicated.
* Analyzes practitioner files for completeness, accuracy, consistency, gaps in work history, relevant references, etc. Identifies issues and initiates further data collection as needed. Communicates handoff to appropriate Medical Staff Office.
* Ensures data is accurately entered and assures completion of the credentialing and recredentialing according to established standards and timelines as evidenced by random audit.
* Initiates and participates in cross-training and cross-coverage of credentialing verification office. Serves as a department resource to employees. Mentors and assists Credentialing Coordinators in all aspects of credentialing functions.
* Maintains thorough understanding of NCQA, The Joint Commission, and Commonwealth of Massachusetts credentialing standards.
* Manages expirables as assigned.
* Organizes and maintains electronic credentialing files.
* Meets assigned file processing quality and quantity standards.
* Generates routine reports to manage inventory and assure timeliness of verifications.
* Other duties as assigned.


* Strong organizational, problem solving, and prioritization skills as demonstrated by the successful and timely completion of assignments.
* Excellent verbal and written communication skills, ability to interact with all levels of personnel
* Keen attention to detail
* Experience working in a team-oriented, collaborative and matrix environment
* Working knowledge of Microsoft Office, Skype and other software used in daily work


* Bachelor's degree or equivalent education and experience

* Three or more years of credentialing experience in a medical staff services department or managed care plan desired.
* Experience with Initial and Recredentialing file processing according to NCQA and TJC standards.
* National Certified Provider Credentialing Specialist Certification preferred.
* Previous supervisory experience a plus.
* Detail oriented with exceptional accuracy
* Excellent organization, follow up and prioritization skills.

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