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Credentialing Specialist

Milwaukee, WI
Duties: *The Credentialing Specialist is responsible for maintaining compliance with regulatory and accrediting bodies, participating in the development and implementation of credentialing processes and procedures, maintaining an accurate provider database and collecting and analyzing verification information for approximately 1300 medical and staff and allied health professionals. Other duties as assigned. 
*Collects, reviews, processes and verifies the credentials of Medical Staff and Allied Health Staff Professionals in accordance with all institutional and governmental rules and regulations to ensure that only qualified providers care for patients in Hospital
*Closely monitors information collection, evaluates adequacy and quality, and pursues additional information when necessary for effective and comprehensive peer review decision-making
Coordinates and facilitates review/recommendation and approval processes per established policies and procedures.
*Conducts "Identity Proofing" for medical practitioners authorized to prescribe controlled substances through review of a valid government-issued photo ID and direct comparison to the practitioner presenting the ID. 
*Reviews the practitioner's credentials file in the credentialing database to validate the presence of primary source verification of the Wisconsin professional licensure and DEA registration. 
*Collects biometric identifiers compliant with DEA requirements for electronic prescribing of controlled substances authorized and approved by client and distributes hard tokens or electronic keys to practitioners who have successfully completed the identity proofing process.
*Forwards the name of the practitioners to the Security Team in Information Technology in accordance with Corporate policy. As required for FMLH Medical Affairs staff.
*In the context of credentialing, provides technical and administrative support to the clinical services/departments and Credentials Committee, and any other committees as required or needed
*Communicates status of verification process to clinical services/departments, and others based on need to know
*Prepares, disseminates and retrieves credentials files sent for review to the clinical services/departments and Credentials Committee
*Maintains current, complete and accurate data in the credentialing software tool.
*Effectively utilizes available technology to maximize productivity and efficiency. 
*Ensures safekeeping of credentialing information through appropriately secured workstations, cabinets, and drawers
*Maintains the Credentialing folders on the Medical Staff intranet site, ensuring that documents are current and available to users
*Performs functions necessary to ensure that the Professional Staff meet/complete all credentialing and compliance requirements associated with Focused Professional Practice Evaluation (FPPE), Ongoing Professional Practice Evaluation (OPPE) and annual and biennial competency assessments
*Monitors time limited credentials for renewal prior to expiration and verifies standing.
*Works and communicates well with physicians, other levels of professional staff, co-workers, hospital staff, and staff from outside agencies.
*Provides information in coherent formats that help expedite analysis and decision-making. 
*Maintains competence through attendance at mandatory activities and other job-related educational opportunities. 
*Supports and demonstrates a customer service commitment to internal and external customers through adherence to Hospital's customer service standards and processes
Skills: Strong proficiency with Microsoft Windows applications. Understands file structure. Proficient at database management with experience using report-writing tools. Knowledge of equipment and tools used to perform credentials verification such as optical scanners, copy machines, fax machines, digital cameras, etc. Effective verbal communication and listening skills. Ability to demonstrate tact and diplomacy. Strong/effective written communication skills. Able to compose letters, minutes and other documents and forms appropriate to the occasion. Knowledge of state and federal regulations that pertain to credentialing in hospitals. Excellent organization skills. Detail oriented. Ability to work as a team member and support team processes. Ability to handle multiple tasks simultaneously. Self-motivated. Accurate typing skills.
Education: High School diploma or equivalent is required. Bachelor's degree in a health care related field or information management is preferred.
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