Specialist - Credentialing

Responsibilities

• Provides credentialing support to the credentialing manager.
• Maintains a sound working knowledge of credentialing and provides consultation to the medical staff regarding credentialing, ensuring all processes are in compliance with state statutes and regulatory agencies.
• Timely processing of initial applications and reappointment applications for completeness and in accordance with Medical Staff standards.
• Secures appropriate peer competency references and prepares credentials files.
• Obtains primary source and other verifications in accordance with established guidelines.
• Communicates with applicants during credentialing process to ensure timely and expeditious completion of process.
• Researches incidents, malpractice claims, advisory letters/letters of concern etc. and request appropriate follow-up information from practitioner or other sources as indicated.
• Maintains the credentialing database. Updates primary source data in the Midas database. Ensures data is accurately entered as evidenced by audit.
• Prepares reports in compliance with requests for information as demonstrated by documentation.
• Maintains adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical and hospital and medical staff policies.
• Affords data security and confidentiality by use of appropriate labeling of information and storage, and appropriately securing cabinets and drawers.
• Captures and maintains all activities of the initial phase of Medical Staff and Allied Health applicants.
• Enters information and updates into the database to include complete biographical profile on new physician and updates and entries for provisional and biennial reappointment of existing medical staff.
• Maintains master physician database.
• Maintains physician files in an orderly manner, making sure all appropriate documents are filed.
• Maintains and regularly updates specific biographical data in the systems.
• Generates reports as needed by systems for inter-department use.
• Phones physician offices regarding meeting attendance, malpractice coverage and DEA certification, etc.
• Notifies all database users of any provider’s additions and/or changes monthly.
• Downloads information from the Internet and conducts searches as needed for project work.
• Maintains and keeps all departmental databases at the time of appointment and reappointment.
• Maintains and updates the Network Webpage Master for Hospital's Website.
• Performs a full range of clerical functions in support of department staff and management including document preparation, filing, office administration, office equipment maintenance and supply procurement, performed within departmental standards and within budgetary guidelines as evidenced by observation and audit.

Requirements

• 1 year, credentialing, medical staff or administrative assistant including data entry, in a hospital or healthcare environment resulting in knowledge of medical terminology and professional physician interface
• 3 years, in a credentials or medical staff services setting