Credentialing Specialist

Now hiring a Credentialing Specialist!

The Credentialing Specialist conducts thorough background investigation on physicians and other providers applying for affiliation with PHS -Albuquerque and regional facilities. This includes reviewing applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence. Identifies issues that require additional investigation and/or follow-up. Responsible for collecting and processing reappointments of Medical Staff members and ensuring they are completed within specified time periods. Processes requests for updated privileges, status changes. Maintains a variety of tickler systems to ensure that processing is timely and meets state and federal regulatory requirements and accreditation standards as they apply to Credentialing. Maintains accurate data in the credentialing database which is accessed by multiple business units within the organization

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Full Time - Exempt: No
• Job is based Presbyterian Hospital
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

High School Diploma. One to three years experience in hospital medical staff or managed care credentialing preferred.

• High School Diploma.
• One (1) to three (3) years experience in hospital medical staff or managed care credentialing preferred.
• Certification or eligibility for certification as a Current certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.
  
  

Education Essential: High School Diploma or GED

• Analyze practitioner applications and/or requests to ensure that required documentation/information has been submitted in order to initiate the primary source verification processes
• Conducts primary source verification of applicants' education, licensure, professional work history, medical malpractice history for the purpose of determining competency and eligibility to be awarded membership and/or privileges
• Prepares processed files for review by appropriate members of medical staff leadership, including identification of information that may require additional investigation
• Utilizes appropriate tracking tools for the purpose of ensuring timely completion of applications
• Collects/analyzes data from various sources to include with initial and/or reappointment applications. Such data includes but is not limited to focused professional practice evaluations, ongoing professional practice evaluations, and privileging eligibility criteria
• Process other credentialing requests, as assigned, in accordance with established policies and procedures
• Responsible for on-boarding and/or orientation of new Medical Staff members, according to established policies and procedures

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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