Credentialing Quality Reviewer

Education Qualifications:

Educational Requirements:

• Associates degree or equivalent experience

Key Responsibilities:

• Quality Review of Credentialing files for National Committee for Quality Assurance (NCQA) and Joint Commission (JC) compliance
• Conducts audits and quality assurance activities related to credentialing
• Training of new team members, creates and updates training materials, provides department training as needed
• Develops and maintains system-wide clinical privilege forms
• Conducts research related to industry standards for privilege criteria and partners with practitioner SMEs to establish appropriate criteria
• Provides overview of proposed privilege form revisions to the Credentials Committees and Medical Staff Executive Committees
• Project coordination for the Medical Staff Services Department
• Identifies opportunities and areas for improvement within the credentialing process, partners with management to address
• Ensures accurate data entry into the credentialing database
• Tracks quality measures to identify trends with team members
• Other duties as assigned 

Required Qualifications:

• 3 years credentialing or equivalent experience

Preferred Qualifications:

• NAMSS (National Association of Medical Staff Services) certification; either CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional in Medical Services Management)
• Working knowledge of medical staff/provider credentialing concepts and comprehensive knowledge of state, federal regulatory requirements and accreditation standards relating to the organized medical staff
• Training and quality assurance experience
• Knowledge of best practices in the development of criteria-based clinical privilege forms