CREDENTIALING SPECIALIST - MED STAFF - FULL-TIME

About the role

Under the direction of the Manager of the MSSD, the Credentialing Specialist (CS) manages the functions required to support credentialing and privileging activities of the medical staff organization. Ensures that the credentialing and privileging activities meet all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation (The Joint Commission standards, state laws, and Medicare Conditions of Participation). This includes application management, primary source verification of credentials, file maintenance (electronic and/or hard copy), maintenance of expiring information, information management, and direct support of the evaluation and decision-making process.

Responsibilities

• Works closely with the Manager of the MSSD, department chairs, and the Credentials Committee to define and delineate appropriate privilege forms and to assist in developing and establishing criteria for the granting of privileges.
• Coordinates application management to ensure a timely application process in Credentialing and Re-Credentialing per the Medical Staff bylaws.
• Assures that data entry of required primary source verification data elements and practitioner credentials files are managed in accordance with procedures outlined in the Medical Staff bylaws, Rules & Regulations, and policies.
• Prepares practitioner information for review and evaluation by medical staff leaders and supports follow-up actions regarding practitioner qualification and competency management.
• Red flags potentially adverse information for Medical Staff leadership review.
• Identifies areas where practitioners may not meet privileging or membership criteria.
• Monitors expiring information such as DEA, license, professional liability insurance, specialty board certification status, etc., and maintains and updates credential files and the practitioner database.
• Supports and works with the Medical Staff Quality Coordinator on competency management functions such as proctoring, focused and ongoing performance evaluations, etc., in accordance with bylaws, rules, regulations, and policies.
• Effectively communicates issues and ongoing status of assigned work to the Manager of MSSD.
• Develops and/or maintains mechanisms for tracking and updating various physician-related information (e.g., Medical Record fines) and communicates this with necessary medical staff personnel.
• Initiates and runs required computer programs to obtain needed physician statistics and pertinent credentialing data.
• Attends physician functions and arranges for appropriate office/phone coverage while away.
• Performs multiple duties and assignments within the same time frame, meeting designated deadlines.
• May be responsible for meeting management for one or more medical staff departments or committees, including scheduling, agenda planning, in-meeting support, post-meeting documentation, and follow-up items.
• Assures that all documentation reflects required activities undertaken by individuals and meeting members and that relevant information is communicated to the MEC, Board of Directors, or others as necessary.
• Maintains all medical staff committee and department meeting minutes for archiving and regulatory compliance.
• Facilitates communications between the medical staff organization and administration in matters requiring cooperation.
• Assists in the maintenance and protection of confidential medical staff credential files and quality files, in conjunction with the Manager of the MSSD.
• Assists in the maintenance, review, and creation of medical staff office policies and procedures, in conjunction with the Manager of the MSSD.

Qualifications

• Two years of credentialing and privileging experience recommended.
• Familiarity with medical and legal terminology desired.
• Ability to work with Microsoft products, credentialing software, and learn new database programs.
• Excellent interpersonal communication skills necessary.
• Ability to work in a highly confidential environment.
• Strong computer skills necessary.
• Knowledge of other business subjects desirable.
• Once meeting eligibility requirements to take the exam, certification is strongly encouraged but not required.

Skills

• Clear communication skills, both written and verbal.
• Knowledge of basic computer programs.
• Able to keep confidential information regarding patients and team members.
• Able to withstand crisis situations.
• Skills to provide customer service to patients, team members, and visitors.
• Experience with Excel, PowerPoint, Word, Visio, etc.

Credentials

• High school graduate or equivalent (Essential).

Pay

Entry: USD $24.14/Hr. Max: USD $37.42/Hr.