Human Resources Credentialing Specialist

Description

The HR Credentialing Specialist is responsible for Haymarket Center’s provider credentialing and primary source verification, maintaining provider licensure, medical malpractice insurance and certifications, assisting with credential committee meetings and preparing credentialing documents for Board Approval.

• Timely processing of initial credentialing and privileging and re-credentialing/re-privileging applications in accordance with  HRSA Policy Information Notices (PIN).
• Timely process, communication and maintain provider background checks, National Practitioner Data Bank (NPDB) queries, malpractice insurance claims, and other relevant sources.
• Perform and maintain primary and secondary source verifications in accordance with HRSA guidelines, state requirements, and Haymarket Center’s policies and by-laws.
• Identify discrepancies, red flags, and adverse action on applications or verifications and conduct research and follow-ups for reporting to Credentialing and Privileging Committee.         
• Maintain credentialing database with electronic files including licensure, certifications, and other required retention documents.
• Attend Credentialing and Privileging Committee meetings, and act on the decisions of the Committee.
• Set up and assist in presenting provider files to Credentialing and Privileging Committee.
• Assist in maintaining provider profiles.
• Maintain confidentiality of documents and information.
• Provide general office support as related to HR.
• Filing employee documents.
• Monitoring staff training and renewals.
• Other duties as assigned by supervisor.

Requirements

• Bachelor’s Degree is required, or any combination of education and experience, which would provide the required knowledge, skills, and abilities may qualify.
• One or more years of experience working in a managed care, hospital, or medical office environment preferred.
• One or more years of credentialing with primary source verification and associated credentialing processes experience preferred.
• Certified Provider Credentials Specialist (CPCS) preferred.