Credentialing Specialist

General Summary: The Credentialing Specialist is responsible for coordinating all medical staff office responsibilities and functions and supports compliance with the Joint Commission and other regulatory agencies relative to all functions of the medical staff. This position serves as a resource and provides support services to physicians, including credentialing, education/orientation, quality assurance/performance improvement and other department and committee activities. This position may perform administrative duties for members of the hospital leadership team. The Credentialing Specialist is actively involved in department activities, transdisciplinary team activities, and LifeCare activities to ensure individualized, patient-centered health care for all patient populations admitted to LifeCare Hospital.

Patient Population: Has contact with patients in a non-clinical setting; understands and demonstrates appropriate behavior when interacting with patients in the adult (18-65 yrs of age) and geriatric (65 and older) populations.

Supervision: Not applicable.

Standard Essential Functions

• The knowledge and skills necessary to perform the position requirements are demonstrated through the successful completion of competencies established for the position, to include population served and other special needs of patients or customers, served by the department.
• Adheres to LifeCare policies, procedures, all safety plans, and all standards imposed by regulatory organizations.
• Regular attendance and timeliness is required.
  
  

Job-Specific Essential Functions

• Effectively coordinates and completes the credentialing process including, but not limited to analysis of eligibility of applicant, tracking of application, verifying applicant’s credentials, monitoring time frames to assure compliance; correlation of data; assessing the application for completeness and/or variances from acceptable data collection and maintains files and records.
• Informs applicants of status of their application, including acceptance to the medical staff and privileges granted. Resolves any conflicting data received during the credentialing process and resolves with applicant.
• Effectively prepares credential files for provisional, appointment and/or reappointment review to include preparation of applicant files for presentation to the Medical Executive Committee.
• Completes the re-appointment process in its entirety to assure medical staff members and allied health professionals are re-appointed within the specified timeframe. Assures completion of medical staff profiles, including appropriate signatures and comments, prior to presentation to the MEC.
• Works with Quality Management to support required focused and ongoing professional performance evaluations of practitioners for the peer review process and prepares reports of findings for presentation to the various committees.
• On an ongoing basis, verifies the current licensure of all credentialed practitioners including current status of controlled substances registrations, board certifications, and medical malpractice insurance coverage documentation and enters information in credentialing software program on a timely basis. Communicates physician contact information and clinical privilege information to appropriate staff. Responds to various hospital organizations’ inquiries regarding medical staff.
  
  

Values

We COLLABORATE: We develop our treatment plans in collaboration with physicians, clinicians, and patient's families.

We ADVOCATE: We advocate on behalf of every patient and family.

We RESPECT: We recognize and value the dignity, rights, and resources of each patient.

We EDUCATE: We educate our team members and families with purpose and compassion.

We SERVE: We serve as a TEAM with integrity at all levels focused on achieving the best possible outcomes for our patients.