Credentialing Specialist in WHITE PLAINS, New York at White Plains Hospital

At White Plains Hospital, you have an opportunity to work side-by-side with some of the most talented people in the world.

We have been widely recognized for our exceptional culture, world-class physicians, Magnet-designated nurses and passionate employees who make a real difference in our community. With tremendous growth opportunities, great benefits, and flexible work schedules, it is no wonder why we are consistently recognized as a Great Place To Work!

Position Summary

The Credentialing Specialist provides all functions of credentialing and re-credentialing processes for medical practitioners on the Medical Staff at White Plains Hospital. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and White Plains Hospital’s regulations, guidelines, policies, and standards. Ensures that members maintain current credentials and licensure to support the mission of White Plains Hospital by delivering quality healthcare. Previous hospital experience with physician onboarding and credentialing is a must.

Essential Functions and Responsibilities Includes the Following:

Understands and adheres to the WPH Performance Standards, Policies and Behaviors

Monitors licensing, education, training, DEA and all aspects of a provider’s medical staff file

Ensures the medical staff is compliant with regulatory and accrediting institutions

Maintains individual provider files to include up to date information prior to committee presentation

Credential new providers and re-credential current providers who hold staff privileges

Work closely with Senior Coordinator and Senior Director to resolve any recredentialing of a providers file

Maintain credentialing database

Run expirable reports and query websites for up-to-date providers credentialing

Communicate in a professional manner with physicians, LHP’s, Departmental Leaders to facilitate the highest standards of credentialing

Research board certification for respective providers

Works closely with MSO team to ensure that the OPPE/FPPE process is being met

Collect and maintain proctoring documents for all providers as needed

Has an understanding to NCQA, TJC, DOH, CMS and all credentialing accreditation bodies

Investigates any malpractice claims, judges, sanctions and opt out providers and brings to Senior Directors attention

Populates verification, privilege and process portals as assigned

Participates in all Team projects as assigned by Senior Coordinator and Senior Director

Prepares reappointment/initial application appointment letters

Partakes in Committee meetings as assigned

Takes attendance and minutes to all meetings as assigned

Supports all medical staff stakeholders by providing administrative support as needed

Performs all other related duties as assigned.

Education & Experience Requirements

• High School diploma (required) with relevant experience. Undergraduate degree preferred
• Knowledge of medical staff credentialing processes, procedures and applicable resources
• Basic medical terminology

Core Competencies

• Ability to work independently and collaboratively
• Ability to multi task and work well under pressure
• Ability to communicate professionally and efficiently with all levels of management and external constituencies
• Self-starter, self-motivated and ability to work without supervision
• Flexible, organized and able to set priorities
• Excellent telephone manners and communication skills
• Exhibit courteous, cooperative and professional attitude at all times

Physical/Mental Demands/Requirements & Work Environment

• Ability to perform computer work for extensive periods of time
• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.

Primary Population Served

Non-patient care population

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.