What are the responsibilities and job description for the Medical Staff Coordinator position at Aston Carter?
Description:
In-depth understanding of managed care systems, credentialing, peer review and quality management programs.
Knowledge of health plan delegation, NCQA and DMHC regulations
Experience in managed care, provider and provider organizations(facility & ancillary) credentialing, quality management and provider relations is essential.
Supporting the values of PH&S-CA and proven ability to use team concepts to enhance shared leadership philosophies are essential for the success of this position.
Credentialing Specialist is responsible for the credentialing functions of the MSO and assists in preparing for audits.
Performs initial and re-credentialing functions, processes and requirements as stated in the approved Credentialing Program, Policies and Procedures.
Primary source verification of licensure, malpractice insurance, hospital affiliations, educational programs, board certifications, licensure sanctions, malpractice claims history, data gathers peer references, and checks for exclusion and/or sanctions with Medi-Cal and Medicare
Performs file maintenance of physician, practitioner, CVO (Credentialing Verification Organization) and facility credentialing files.
Performs system management of Credentialing database including creation and revision of letters and reports, module development, on-line application processes and website physician directory.
Supports the Credentialing Committee including minutes, reporting and any follow-up directed by management.
Assists to monitor licensing and regulatory agencies for adverse action identification and performs follow-up as appropriate. Performs research of adverse actions as identified in approved policies and procedures.
Reports to and confers with the Management and Medical Director regarding any potential quality of care/service concern, potential risk management, or peer review issue.
Assists in the preparation and revisions of the Credentialing Program and Policies & Procedures to be compliant with NCQA, health plan, state and federal regulations.
Performs on-site physician/practitioner office evaluations and any Corrective Action Plan follow up required.
Assists with the training of Provider Office staff regarding their credentialing responsibilities.
Assists to perform and/or maintain the expiring documents program including reporting non-compliant practitioners to the Credentialing Committee.
Assists to prepare for on-site health plan annual credentialing audits, including auditing files to ensure compliance with credentialing, re-credentialing and on-going monitoring standards.
Performs health plan notification of newly credentialed practitioners as directed.
Assists to perform system reconciliation against internal and external rosters.
Perform reporting requirements to the UM/QM & Credentialing Committees, Board of Directors and Health Plans.
About Aston Carter:
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At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
Salary : $25 - $31
