Senior Medical Staff Credentialing - Full Time - Day Jobs in Holmdel at Hackensack Meridian Health

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Senior Medical Staff Credentialing Specialist is responsible for the integrity of all aspects of the credentialing cycle. This role collaborates with Centralized Verification Office and Medical Center leaders to promote practitioner advocacy, departmental effectiveness, and regulatory readiness and to ultimately ensure we have the most qualified providers for patient safety. This position serves as a subject matter expert for the department, providing guidance to team members, managing complex cases, and leading quality improvement initiatives.

Responsibilities

A day in the life of a Senior Medical Staff Credentialing at Hackensack Meridian Health includes:

 

• Serves as the lead point of contact for medical staff office team members and physicians with difficult situations, resolving challenges with credentialing, answering questions, intervening with physician concerns.
• Assists with training and guiding new medical staff office team members.
• Audits credentialing files prepared by other team members to ensure accuracy, consistency, and compliance with regulatory standards.
• Collaborates with the Centralized Verification Office (CVO) to ensure effective and efficient initial and/or reappointment process for all applicants to the Medical and Dental Staff ensuring compliance with regulatory bodies (The Joint Commission, CMS, federal and state), as well as the Medical Staff Constitution and Bylaws and Rules and Regulations.
• Functions as the primary onsite specialist to correct, clarify, and complete the initial appointments of providers.
• Works closely with Department Chairs, administrators, physicians and applicants to facilitate resolution of credentialing issues and concerns. 
• Maintains and organizes all information needed for the credentialing process. As needed, researches and conducts primary source verification for all components of the credentialing file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Identifies opportunities for process improvement and assists the Manager in developing and implementing updated policies and workflows. 
• Prepares credentials files for presentation to the Credentials Committee, flagging any issues the Committee and/or Chair may need to be alerted to. 
• Facilitates Credentials Committee meeting with the committee chair to review agenda issues prior to the committee meeting.
• Assigns reviewers for each applicant prior to Credentials Committee meeting and provides files and material to reviewer. Follows up on any questions reviewer might have, obtaining additional information from applicant or outside sources.
• Processes requests for privileges, ensuring compliance.
• As appropriate and in accordance with TJC standards, conducts Ongoing Professional Practice (OPPE) using the HMH selected vendor.
• As appropriate, follows up on OPPE outliers with the Section Chief and or Department Chair.
• As appropriate and in accordance with TJC standards, assists with preparing the Focused Practice Professional Evaluation (FPPE) Plan with the Section Chief and or Department Chair.
• As appropriate, follows-up on the FPPE plan to be sure all elements are completed.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Utilizes credentialing database, optimizing efficiency, and performs query, report and document generation.
• Documents all actions of the Credentials Committee.
• Processes all actions following approval by the Board of Trustees.
• Processes temporary privileges for new staff members.
• Processes necessary documentation and submits for temporary privileges, resignations, status changes, new access etc.
• As appropriate, verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Takes appropriate actions when the practitioner is out of compliance. 
• Participates in surveys and audits of regulatory and accreditation agencies or organizations.
• Obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance. 
• Assists applicants and their departments with leaves of absence and resignations. 
• Coordinates with Human Resources in onboarding for new members of the medical staff.
• Reviews Sanction sites for practitioner license/managed care actions.
• Collaborates with Manager and Department Chairs and other key staff members in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven. 
• Performs other duties as required. 
• Processes requests for change of collaborating/supervising physician agreements.
• Coordinates with Team Health, Human Resources, Risk Management, Chairs, Administrators to bring the credentialing process to completion. 
• Provides support and works in conjunction with the CMO and medical staff leadership as needed.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate's degree or a combination of education and/or 4 years of prior credentialing or hospital medical staff office experience.
• Minimum of 3 years of credentialing experience in a Hospital Medical Staff Office with knowledge of medical credentialing and privileging procedures and standards, as well as knowledge of related accreditation and certification requirements.
• Exercises a high degree of initiative, judgment, discretion, and decision-making skills to achieve objectives.
• Excellent written and verbal communication skills. 
• Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Education, Knowledge, Skills and Abilities Preferred:

• Previous experience with credentialing databases.

Licenses and Certifications Preferred:

• NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Compensation
Minimum rate of $29.38 Hourly

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.