Credentialing Specialist - Medical Staff (PRN)

POSITION SUMMARY

Responsible to facilitate all aspects of credentialing, including appointment, reappointment, monitoring, privileging, and status for Medical Staff. Distributes, reviews, and verifies credentialing applications. Sets up and maintains provider information in an online credentialing database system. Tracks license and certification expirations for all providers to ensure timely renewals. Specialist will work closely with the Medical staff Director and respective Medical Staff Committees including Credentials to ensure accurate and timely credentialing and support clerical duties for the Medical Staff.

PRIMARY (ESSENTIAL) DUTIES

• Evaluate the current credentialing processes and procedures including policy and process modification changes as needed ensuring compliance with CMS & JC standards.
• Performs the credentialing processes for all initial applications and reappointments in a timely and complete manner.
• Collects and verifies sensitive provider data through confidential sources and maintains a credentialing database.
• Prepares files for presentation and approval to the service chair, credentials committee, CEO, medical executive committee and hospital board.
• Performs analysis and appropriate follow-up of each initial application and reappointment.
• Works with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physician office staff.
• Performs relevant data entry into the database to ensure consistency, completeness, and integrity of data.
• Processes appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and maintains documentation in the database.
• Guides privileging process including form development and monitoring.
• Accurately maintains current Medical-Dental Staff roster.
• Keeps current on latest recommendations from CMS and TJC related to accreditation, credentialing, and quality improvement activities.
• Consistently exhibits working knowledge of Medical Staff Bylaws, Rules and Regulations and departmental policies and procedures and makes every effort to insure Medical Staffs' compliance within these parameters.
• Tracks FPPE and adds to the respective Medical Staff Committees in a timely manner for action.
• Notifies in a timely manner, hospital departments/service of new Medical Staff granted privileges.
• As assigned, assists with agenda management, packet development and information distribution for Medical Staff committee meetings.
• As assigned attends or Medical Staff committee meetings and coordinates virtual meeting, takes minutes composing timely ensuring that information is accurately presented and sensitive nature of material is preserved. Additionally, accurately records attendance. Assists in obtains committee chairperson signatures. Coordinates virtual meeting including timely set-up; displays and share content as requested; and coordinates other virtual activities.
• Coordinates new Medical Staff member on-boarding including orientation scheduling with respective departments and applying for computer access.

SECONDARY DUTIES

• Assembles and distributes as assigned meeting packets in an accurate, timely manner.
• Accurately and efficiently prepares mailings (electronic preferred) to the Medical-Dental Staff as requested.
• Maintains and supports the multifaceted Medical Staff filing system according to regulatory guidance and allows for easy retrieval of information.
• Acts as a resource person for the Medical Staff and Allied Health Staff in a courteous and cooperative manner.
• Establishes and maintains email contact list in Outlook directory for Medical staff in total, by specialty, and by committee.
• As assigned, prepares ballots for annual election of Medical Staff officers, and any other Medical Staff election, as directed by the Director and Chief of Staff.
• As assigned, assists in planning Medical Staff social events including attending and supporting the event.
• Supports the OPPE process including providing reports or other information as requested.
• Willingly shares responsibility for telephone and clerical duties in the Medical Staff office, professionally and courteously performing such duties as mail delivery, taking messages, scheduling appointments and meetings, acting as copier key operator, etc.
• Participates in departmental Briefs, Debriefs, Huddles (may include other departments), Learning Boards and Executive Patient Safety Rounds.
• Participates in process improvement opportunities.
• Participates in education opportunities.
• Relies on instructions and pre-established guidelines to perform the functions of the job.
• Performs other related duties as assigned.

Experience

• Demonstrated ability to meet deadlines in a multi-functional task environment with excellent organizational skills and the ability to establish daily work priorities
• Typing, 60 WPM, with a high degree of quality
• Strong verbal and written communicative skills required
• Knowledge of medical terminology required
• Three (3) years' secretarial experience required

• CPCS, Certified Professional Credentialing Specialist preferred
• Previous credentialing experience preferred

Education

• High School Diploma or GED or better

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)