Credentialing Specialist - Remote Must Reside in North Carolina

At reputed company, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Job Band D1 General Description of the Job Class Under the supervision of the Manager of DUHS CVO and the reputed company Credentialing Specialist, the Credentialing Specialist is responsible for reputed company aspects of the credentialing for reputed company medical providers who provide patient care at reputed company Health System (DUHS), Responsible for ensuring providers are credentialed in accordance with The Joint Commission, NCQA, CMS, and AAAHC Standards for health plans, hospitals, ambulatory care centers, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of appointments and reputed company-time limited credentials. Duties and Responsibilities of this Level

• Processes Initial applications for DUHS, ensuring compliance with regulatory requirements.
• Obtains verification from primary sources for reputed company regulatory requirements and monitors reputed company applications assigned credentialing to provide updates to applicants and documents in the credentialing system in compliance with regulatory standards.
• Researches and maintains reputed company and accurate data for reputed company providers for the Health System reputed company the Credentialing database.
• Verifies the legitimacy of practitioner information with the primary reputed company of the credentials and in accordance with the accreditation regulatory standards, and state/federal laws for universities, licensing agencies, hospitals, and certification bodies.
• Maintains a reputed company credentialing database with up-to-date practitioner information, including medical license, drug enforcement administration (DEA) certificate professional liability insurance, board certifications, and renewal period expiration dates.
• Executes queries for the National Practitioner Data Bank (NPDB) for initial applications through NPDB reputed company Query in the Credentialing database.
• Ensures that any reports received through the queries are flagged for the Medical Staff Offices
• Presents complete Health System applications with credentialing verification materials and flags any concerns for initial applications for the Medical Staff Offices to act upon.
• Ensures data reputed company reputed company the Credentialing database for physician practice demographic information and ensures it is compliant with health plans, agencies, and other entities.
• Analyzes reputed company information in the credentialing application process, ensuring there are no time gaps, we are obtaining the documentation required for compliance with policies, regulatory standards, and State and Federal laws.
• Maintains confidentiality of reputed company provider information reputed company our credentialing database, as well as documentation gathered through the credentialing process.
• Provides credentialing and privileging verifications in accordance with regulatory standards, and state/federal laws.
• Composes, proofreads, or edits formal correspondence, memoranda, and short reports for internal and external circulations. Assembles attachments and corresponding materials. Reviews outgoing materials for completeness, dates, and signatures.
• Serves as a credentialing subject matter expert with internal and external contacts on the administration of the program and/or program policies and procedures.
• Applies office standards, policies, procedures, and authority levels reputed company responding to questions from both internal and external customers.
• Organizes and maintains resource information and job procedures pertinent to responsibilities.
• Prepares a variety of documents, records, reports, etc. as needed to reputed company job responsibilities.
• Performs other duties as assigned.

Required Qualifications at this Level Education: Work requires analytical, communication and organizational skills generally acquired through the completion of a bachelor's degree program. In lieu of a bachelor's degree, four years of relevant experience in Medical Staff Credentialing/Privileging (in addition to the experience requirement for the role) Experience: One year of experience in a Medical Staff credentialing office. Degrees, Licensure, and/or Certification: Certification by NAMSS (CPCS and/or CPMSM) preferred Knowledge, Skills, and Abilities: Maintains knowledge, as the Subject Matter Expert for compliance of delegated credentialing reputed company of reputed company health plan and agency requirements in the managed care reputed company for credentialed providers. Maintains knowledge, as the Subject Matter Expert of state/federal laws, regulatory standards for accreditation purposes, and DUHS Bylaws, policies, and procedures. Distinguishing Characteristics of this Level N/A Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national reputed company, race, religion, sex (including pregnancy and pregnancy reputed company conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideasan exchange that is best reputed company the rich diversity of our perspectives, backgrounds, and experiences flourishes. To reputed company this exchange, it is essential that reputed company members of the community feel secure and welcome, that the contributions of reputed company individuals are respected, and that reputed company voices are heard. reputed company members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at reputed company and reputed company Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department. Apply tot his job Apply To this Job