Medical Services Professional I

Day (United States of America)

Medical Services Professional I

The Medical Services Professional supports departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, enrollment, and source verifications. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility.

• High School Diploma Required; Associate degree preferred
• Certified Credentialing Specialist (CPCS) preferred
• Experience in provider credentialing, payer enrollments and/or Medical Staff services a plus
• Very strong customer service orientation, positive attitude, highly self-motivated, directed and change oriented
• Must have strong interpersonal skills; the ability to respond appropriately to inquiries in a timely manner; prioritizing workload is mandatory
• Inspires trust and confidence among stakeholders through reliability, authenticity, and accountability.
• Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward and across the organization by actively listening and encouraging the open expression of ideas and opinions.
• Displays a credible presence and positive image. Uses appropriate protocol for professional and social situations.
• Establishes productive, cooperative relationships with subordinates, peers, management, and stakeholders both internal and external to the organization.
• Conducts, participates in, and maintains credentialing and privileging
• Determines applicant’s initial eligibility for membership/participation.
• Compiles, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies
• Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information
• Accurately and timely processes Medical Staff appointments, reappointments and enrollment applications according to organizational policies; operational procedures; and governmental and regulatory agency standards.
• Conducts, participates in, and maintains primary source verification
• Obtains and evaluates information from primary sources.
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources.
• Verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
• Provides responses to external queries regarding practitioners’ status.
• Maintains credentialing database to ensure that accurate and current information is available to all stakeholders.
• Enroll/re-enroll providers joining the HHCSI group into governmental and commercial insurance plans as contracted, in an expedited manner.
• Works with Hospital Managers, leadership, physicians, allied health professionals and staff in a professional manner.
• Protect provider confidential information and documents.
• Communicate effectively with all contracts both internal and external in order to accomplish enrollment goals.
• Must comply with all Halifax Health policy and procedures manuals
• Completes annual learning requirements, reviewing fire safety and Isolation precaution policies, applicable code reviews, disaster plan reviews, policies on handling hazardous and toxic substances, and risk management issues.
• Demonstrates an interest in patient safety education and participates proactively in identifying problems and incidents in the department and throughout the hospital which place any patient, visitor, or staff member at risk or injury.
• Modifies work schedule to meet department goals and deadlines.
• Follows EMTALA, HIPAA, payer, Joint Commission, URAC, NCQA, CMS and other regulations and standards.
• Observes hospital and department guidelines concerning dress and display of name badge, presenting an appearance appropriate to the work environment.
• Adheres to department customer service standards.
• Readily identifies work that needs to be performed and completes it without needing to be told.
• Demonstrates a positive and friendly demeanor even in stressful situations to ensure a positive experience for all customers.
• Communicates in a respectful, positive way with fellow colleagues.
• Other duties as assigned.