[Hiring] Credentialing Specialist @Duke Careers

Role Description

Under the supervision of the Manager of DUHS CVO and the Lead Credentialing Specialist, the Credentialing Specialist is responsible for all aspects of the credentialing for all medical providers who provide patient care at Duke University Health System (DUHS).

• Responsible for ensuring providers are credentialed in accordance with The Joint Commission, NCQA, CMS, and AAAHC Standards.
• Maintain up-to-date data for each provider in credentialing databases and online systems.
• Ensure timely renewal of appointments and all-time limited credentials.
• Processes initial applications for DUHS, ensuring compliance with regulatory requirements.
• Obtains verification from primary sources for all regulatory requirements and monitors all applications assigned credentialing.
• Researches and maintains current and accurate data for all providers for the Health System within the Credentialing database.
• Verifies the legitimacy of practitioner information with the primary source of the credentials.
• Maintains a complex credentialing database with up-to-date practitioner information.
• Executes queries for the National Practitioner Data Bank (NPDB) for initial applications.
• Ensures that any reports received through the queries are flagged for the Medical Staff Offices.
• Presents complete Health System applications with credentialing verification materials.
• Ensures data integrity within the Credentialing database for physician practice demographic information.
• Analyzes complex information in the credentialing application process.
• Maintains confidentiality of all provider information within the credentialing database.
• Provides credentialing and privileging verifications in accordance with regulatory standards.
• Composes, proofreads, or edits formal correspondence, memoranda, and short reports.
• Serves as a credentialing subject matter expert with internal and external contacts.
• Applies office standards, policies, procedures, and authority levels when responding to questions.
• Organizes and maintains resource information and job procedures pertinent to responsibilities.
• Prepares a variety of documents, records, reports, etc. as needed to perform job responsibilities.
• Performs other duties as assigned.

Qualifications

• Work requires analytical, communication and organizational skills generally acquired through the completion of a bachelor's degree program.
• In lieu of a bachelor's degree, four years of relevant experience in Medical Staff Credentialing/Privileging.
• One year of experience in a Medical Staff credentialing office.
• Certification by NAMSS (CPCS and/or CPMSM) preferred.

Requirements

• Maintains knowledge as the Subject Matter Expert for compliance of delegated credentialing contracts.
• Maintains knowledge of state/federal laws, regulatory standards for accreditation purposes, and DUHS Bylaws, policies, and procedures.

Company Description

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging.

Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes.

To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard.

All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.