Credentialing Specialist

Job description

POSITION SUMMARY: Supports departmental activities to ensure quality in conducting, maintaining and communicating physician and provider credentialing, privileging and verifications, in compliance with both facility and accreditation requirements, including National Committee for Quality Assurance (NCQA) Credentialing and Recredentialing (CR) standards . Ensures processes adhere to NCQA guidelines for timeliness, primary source verification, documentation, file integrity, and audit readiness . Serve as a resource to and collaborates with others to advance the quality of practitioners and patient safety. - Conducts, participates in, and maintains credentialing and privileging. - Determines applicant's initial eligibility for membership/participation. - Complies, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies. - Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information. - Participates in the development and standardization of credentialing workflows to align with NCQA accreditation, delegation, and centralize...