Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.
The Medical Board Office at SUNY Downstate Health Sciences University is seeking a full-time Lead Credentialing Specialist / TH Staff Assistant 1.
The Lead Credentialing Specialist reports to the Director of the Medical Board office and is involved in all phases of credentialing and re-credentialing and managed care enrollment. The Lead Credentialing Specialist must possess and maintain expertise in Joint Commission and NCQA standards and requirements and must not only be an expert credentialing specialist, but must also be able to work independently to organize and coordinate the entire credentialing process from start to finish. In the absence of the Director, the Lead Credentialing Specialist will oversee the operations of the Medical Board Office.
The performance of these duties may involve work outside of usual business hours.
Primary duties and responsibilities:
Run regular reports to ensure the timely processing of Initial Applications and Reappointments and submission of recommendations regarding application approvals, increase/decrease in privileges, resignations, and terminations for presentation and review by the Credentials Committee, the Medical Executive Committee and the Governing Body.
Organize the Medical Board Office’s substantive daily activities related to Hospital privileging and health insurance plan/program enrollment. Work to ensure timely completion of processes and to ensure Provider credentials are up to date, specifically, NY State Licenses, DEA, Infection Control, ACLS, BSL and Malpractice Insurance Coverage.
In the Director’s absence, organize, coordinate, and facilitate the Credentials and MEC meetings.
Maintain familiarity with the medical staff bylaws so that in the Director’s absence, the Lead Credentialist can advise hospital administration and medical staff officers on matters of medical staff procedure.
Utilize and maintain accurate data input to the Credentialing System (Cactus) for the following: optimize workflows for the appointment and reappointment of Medical Staff; track and report status of provider applications to the Clinical Departments and Health Plans; and ensure timely submission of documents to and from the Health Plans and ensure providers are enrolled/disenrolled and participating.
Review requests from external agencies (i.e. 2805s) and internal departments (applications) for provider files/provider data and respond appropriately and in a timely manner.
Assist with ongoing/routine review of provider files (initials and reappointments)--both hard copy and electronic--prepared by the Medical Board Office Staff for approval by committees in accordance with medical staff bylaws. This includes sign off/approval of files for which all credentialing processes have been completed and are ready for committee review.
Ensure accurate and timely updates post Credentials Committee and Medical Executive Committee to the Credentialing Database, as well as timely notification of updates to the applicants, departments, and to the Managed Care entities.
Ensure compliance with all regulations and accreditation standards for survey by regulatory agencies, accreditation bodies and for health plan audits.
Assist with preparation for any and all regulatory agencies surveys or audits.
Maintain current knowledge of Joint Commission, DOH, IPRO, Medicare/Medicaid Managed Care, and NCQA Standards and the unique requirements of all provider credentialing and re-credentialing systems.
Plan, prioritize and manage work time efficiently to attain targeted goals.
10 years of experience in hospital medical staff credentialing and the coordination of all credentialing office duties.
Thorough understanding of Joint Commission, NYSDOH and NCQA standards and requirements.
Knowledge of managed care credentialing.
Current CPCS or CPMSM Certification or obtain within 2 years of hire.
Excellent written and verbal communication and computer skills, including proficiency in Excel.
Expertise in at least one credentialing software.
Expertise in use of SYMPLR Cactus software.
Monday to Friday; 9:00am to 5:00pm
Commensurate with experience and qualifications
COVID-19 Vaccination Requirement:
An approved COVID-19 vaccination.
Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at firstname.lastname@example.org.
Equal Employment Opportunity Statement:
SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.
Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.
If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at 718-270-3025.
SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.