Medical Staff/Credentialing Specialist - FT - McAllen

Responsibilities

• Assists in the management of the medical staff support function for the Medical Staff Organization as outlined in the Medical Staff Bylaws.
• Captures and processes credentialing and privileging applications; conducts primary source verifications; reviews and analyzes applications, identifies and follows up on "red flag" items; prepares files for review and recommendation by the MSS department leadership and medical staff.
• Schedules, coordinates, prepares agenda, takes minutes, and follows up on medical staff committees outlined in the Medical Staff Bylaws.
• Prepares summary reports of credentialing/privileging recommendations and ensures the flow of information and action items for medical staff committees, policies, and procedures.
• Affords assistance in coordinating, tracking, and monitoring the FPPE process, ensuring compliance with regulatory standards and policies.
• Under the direction of System Director and Manager, interprets Federal, State, local, and government/insurance agency regulations and guidelines, Medical Staff Bylaws, rules and regulations, policies and procedures; advises providers, management, and administrators on compliance issues as appropriate.
• Generates queries and reports from credentialing and privileging databases.
• Affords assistance in the development and maintenance of clinical privileges and the privilege database.

Qualifications

• Minimum of three years experience in Medical Staff Services and credentialing and privileging in a hospital setting.
• Must possess and maintain a valid NAMSS CPCS certification or meet the eligibility requirements to obtain it within one year of employment.
• Associates or Bachelor’s Degree preferred.