Description
The Credentialist is responsible for ensuring the collection of required credentialing documents and identifying discrepancies against established standards from the designated State Medical or Osteopathic Board or other relevant entities. This role requires managing relationships with physicians, institutions, and strategic partner groups to ensure smooth credentialing processes.
Key Responsibilities:
Application Review & Interpretation:
- Review medical professional applications and interpret their applicability for designated recipients.
- Effectively interpret and apply the Federation Credentials Verification Service (FCVS) credentialing workflow processes.
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Data Entry & Document Processing:
- Perform necessary data entry into credentialing systems.
- Process Medical and Graduate Medical Education documents received.
Communication & Verification:
- Communicate with medical professionals, institutions, and external organizations to collect necessary verifications for FCVS profiles.
- Perform follow-up actions to ensure timely credentialing verification.
- Collaborate with other workgroups to facilitate credentialing processes.
Document Management & Review:
- Add applicant documentation into credentialing profiles as needed.
- Compare source documents to application information, identifying omissions and anomalies, and take appropriate actions.
- Review Physician Information Reports for discrepancies and ensure required actions are taken.
Customer Service & Performance:
- Provide internal and external customer service in accordance with established guidelines.
- Maintain high levels of performance metrics for both productivity and quality.
Specialized Duties (As needed):
- Identify and suggest process or technology improvements to enhance productivity and quality.
- Assist in validating departmental Standard Operating Procedures (SOPs).
- Collect information for NCQA certification processes as required.
- Other duties as assigned
Required Skills and Qualifications:
- Ability to manage relationships with physicians, institutions, and other strategic partners.
- Strong organizational skills and attention to detail.
- Effective communication skills, both written and verbal.
- Ability to follow established credentialing processes and workflows.
- Proficiency in data entry and document management.
- Ability to review complex documents and identify discrepancies.
- Experience working with credentialing systems and related technologies is a plus.
FSMB is an EEO/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin or status as a protected veteran.
Requirements
Education:
- Minimum of an Associate's Degree or 3-4 years of related work experience.
Experience:
- 3-4 years of office experience, including 2+ years of credentialing experience is a plus.
- Customer service experience, preferably in a healthcare or professional association setting.
Technical Skills:
- Typing/data entry skills of 45-50 words per minute.
- Working knowledge of the Windows environment, preferably with proficiency in Microsoft Office (Word, Excel, Outlook).
What do we offer?
At FSMB, you work in an environment that feels like family. FSMB offers a hybrid work environment. Physical presence at the office is an essential job function of this role which the FSMB deems critical to camaraderie, collaboration, innovation, productivity, employee well-being and engagement, and enhances the Company culture.
In addition, we offer:
- Hybrid work environment with in-office and work-from-home days
- Generous vacation plus paid holidays
- 401K with generous employer match
- 10% in profit sharing
- Medical / Dental / Vision / Life Insurance
- Onsite fitness facility
- Tuition Reimbursement