Credentialing Specialist

Coordinate the credentialing of applicants for membership and reappointment in compliance with defined schedules. Collect and analyze information thoroughly to identify potential quality of care issues, behavioral problems, appropriate education and training. Prepare and manage credentialing and re-credentialing applications for completeness and accuracy, maintain and monitor steps of the enrollment and re-enrollment process. Maintain an accurate enrollment database, coordinate flow of information between Credentialing Services, Revenue and Billing departments. Investigate issues of concern, generate reports and present findings to facilitate recommendations to the Board of Trustees. Process applications, including those from Allied Health professionals, for initial appointment and reappointment for Provider Enrollment Plans to the medical staff of multiple Virtua entities, in a timely manner. Maintain required Medical Staff documents to ensure compliance, including FPPE and OPPE for medical staff through appointment and reappointment process. Prepare Committee agenda and supporting material with Committee Chair. Attend meetings, record minutes, and ensure prompt follow up on actions taken by the Committee. Demonstrate accurate knowledge of Medical Staff Bylaws, policies and procedures and external accrediting agencies, such as JCAHO, NCQA as well as state and federal regulatory agencies. Participate in project related functions in the department, assist other team members as required, complete other duties as required to support the success of Provider Enrollment.