Internal Credentialing Specialist

Job Description

Job Description

The Internal Credentialing Specialist will be part of our Internal Credentialing department working closely with the sales team and our risk department. The Internal Credentialing Team provides white glove customer service to our physicians, advanced practitioners, and internal staff by processing Hayes Locums credentialing files. Your personal drive for excellence in service, detail orientation and interest in credentialing is imperative for this role. This team is known for being the secret ingredient to the successful placement of our physicians and advanced practitioners.

Responsibilities :

• Perform primary source verifications of perspective providers' credentials with special emphasis on provider issues relating to malpractice claims, privileging, criminal concerns, license anomalies and discrepancies in education.
• Responsible for verifying medical licenses, criminal background checks, and other queries as needed.
• Reviews reports for disciplinary actions and follows up accordingly.
• Analyze provider applications and curriculum vitae / resumes for consistency and accuracy.
• Contacts provider peer references over the phone, email, or fax about the providers clinical performance skills.
• Contacts the provider to obtain documents and / or explanations for malpractice claims, gaps in work history / medical education, etc...
• Creates urgency with hospitals, universities, peer references, etc. through follow up calls to expedite verification completion.
• Works with the sales consultants to address and resolve incomplete information and / or documentation before submitting the file to the Risk Dept.
• Works closely with the Risk Team to ensure that the credentialing file meets the guidelines that are set in place.
• Completes work on time; proactively communicating progress and issues to relevant parties.
• Adhere to weekly and monthly KPI’s by prioritizing and meeting deadlines while maintaining quality and production expectations.
• Contributes to a positive company and team culture while building camaraderie and inspiring teamwork and trust.
• Performs other duties as assigned

Qualifications