Centralized Credentialing Specialist

Inova Center for Personalized Health is looking for a dedicated Medical Staff Credentialing Specialist to join the team. This role is Full-time working Monday-Friday, 8am-4:30pm | Hybrid

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave.

Medical Staff Credentialing Specialist Job Responsibilities:

• Processes practitioner applications for initial appointment and/or reappointments.
• Manages, supports and maintains credentials files on all medical staff members and advanced practice providers. Consults and works with other hospital departments to coordinate process.
• Assures compliance with regulatory requirements and accrediting body standards, Bylaws and policies. Consistently reviews regulatory requirements, accrediting body standard, Bylaws and policies to maintain current knowledge.
• Initiates and processes application with thorough review and evaluation.
• Plays a proactive role in improving processes within the department for maximum efficiency by participating/leading process improvement activities.
• Communicates status of application to practitioners and all interested parties.
• Appropriately identifies and escalates extraordinary information, time gaps and potential discrepancies and adverse information, and independently investigates and validates information on applications, primary source verifications or other sources.
• Conducts follow-up and research regarding additional required information. Documents appropriately.
• Manages, supports and maintains the Network Insurance Credentialing process for appropriate employed practitioners.
• Completes audit updates on Network Insurance files.
• Obtains additional information for all Network Insurance applications with pending and closed lawsuits.
• Works to ensure applications are completed within the required timeframe to meet the appropriate Credentialing Committee Deadlines.
• Reviews Privilege request forms for accuracy and provides criteria as appropriate. Notifies practitioner that privilege will be withdrawn if criteria not received by deadline.
• Maintains credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders.

Minimum Requirements:

• Education: High School diploma or equivalent
• Experience: 1 year of experience in healthcare setting or customer service; or, BA degree and no experience.

Preferred Qualifications:

• Medical - Credentialing experience