Credentialing Specialist

CHI Memorial Hospital now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health is once again the only hospital in the Chattanooga area to be named a Best Regional Hospital by U.S. News & World Report. We are proud to be the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia. We offer the following benefits to support you and your family: On-site childcare with extended hours Care@Work premium account for additional support with children pets dependent adults and household needs Employee Assistance Program (EAP) for you and your family Paid Time Off (PTO) Health/Dental/Vision Insurance Flexible spending accounts Voluntary Protection: Group Accident Critical Illness and Identify Theft Adoption Assistance Tuition Assistance for career growth and development Matching 401(k) and 457(b) Retirement Programs Wellness Program Additional incentives for eligible full time day shift and night shift opportunities

*Responsibilities*

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of CHI Health System credentialing and CHI Health Credentialing Verification Organization. This includes initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff and Advanced Practice Clinicians. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.

*Essential Key Job Responsibilities*

• Reviews practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares credentials file for completion and forwards all information to the applicable entities ensuring file completion within time periods specified.
• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Assists with managed care delegated credentialing audits.
• Utilizes the Medical Staff credentialing database, optimizing efficiency, and performs query, report and document generation.
• Monitors the initial, reappointment and expirables process for all medical staff, APC staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.

*Qualifications*

• High School diploma or equivalent required
• Ability to communicate effectively, both orally and in writing.
• Program planning and implementation skills.
• Knowledge of related accreditation and certification requirements.
• Knowledge of medical credentialing and privileging procedures and standards.
• Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
• Working knowledge of clinical and/or hospital operations and procedures.
• Informational research skills.
• Ability to use independent judgment to manage and impart confidential information.
• Database management skills including querying, reporting, and document generation.
• Ability to make administrative/procedural decisions and judgments.

*Pay Range*

$19.68 – $27.06 /hour