Corporate Credentialing Specialist

Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Shriners Children’s is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a remote Corporate Credentialing Specialist reporting into our Headquarters location.

The Corporate Credentialing Specialist coordinates and organizes ongoing credentialing and privileging of physicians and advanced practice professionals. Responsible for review, analysis and follow up of credentialing and privileging applications, maintaining strict confidentiality. Ensures compliance with federal and state agencies, organizational policies and accrediting and regulatory agencies.

Shriners Children’s is an EOE/Drug-Free, Smoke-Free Workplace

Position Responsibilities

Verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards; as well as manages communication to providers and primary facilities to ensure notification of upcoming expirables. – 25%
Responsible for confidentiality and data entry, maintenance, and analysis of clinical provider information within database per established guidelines to ensure complete electronic credential file to support provider enrollment and delegation requirements. – 25%
Coordinates and organizes credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested privileges, membership. – 20%
Recognizes, investigates, and validates discrepancies and adverse information obtained; obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance. – 10%
Collaborates credentialing, OPPE, FPPE and privileging activities with SHC Medical Staff Offices to ensure timely approval process of governing bodies, participation in accreditation surveys and audits, to include verification of appropriate drug and criminal background screenings. Prioritizes workload to meet deadlines. – 10%
Maintains current knowledge of accreditation standards (TJC, NCQA), state and federal regulations, as well as SHC medical staff bylaws, regulations, and procedural rules. – 5%
Flexible and responsive with other assigned duties. – 5%

Experience Required/Preferred

1 year of hospital regulatory credentialing experience required
1 year of experience maintaining all required data in MD Staff or relevant credentialing database required

Education Required/Preferred

High School/GED required
Associates Degree in related field preferred
CPCS or CPMSM certification required (it not currently certified, CPCS will be required within 24 months of hire or upon eligibility)

Knowledge, Skills & Abilities

Effective written and verbal communication skills
Analytical thinking and attention to details
Ability to work independently but also have a strong commitment to being a team player
Ability to prioritize and maintain results in a fast-paced environment, with conflicting deadlines.
Demonstrable proficiency in Microsoft Office Applications (Excel, Access, Word, PowerPoint, Outlook, etc.)