CREDENTIALING COORDINATOR, MEDICAL STAFF SERVICES

Description

Location: Main Campus
Department: MEDICAL STAFF SERVICES
Schedule: Full Time, 8 HR Day Shift,

POSITION SUMMARY:

Plans, organizes, and maintains centralized, comprehensive credentialing for the Medical Staff that includes pre-applications, initial appointment, annual review, reappointment, proctoring, and privileging in accordance with regulatory, accrediting agency and bylaws requirements, assuring accuracy, and providing reports as required/requested. In the process of credentialing and re-credentialing, run background checks, DEA checks, license checks, reference checks, make determination to ensure valid and current. Determines if results of background check, education, licensing, health related requirements and national data bank results, meets the qualifications to proceed further in the application process. Recognize, investigate and validate discrepancies and adverse information obtained from the application, primary source verifications, or other sources. Make a decision around the discrepancies and present to the Director of Medical Staff Services. Works closely with the CMO, Chief of Staff, Department Chairmen, Section Chief’s, PQC, AHP/LLP and Medical Staff Director in the review/recommendation process, including recommendations adverse to the applicant. Confirms that current knowledge, as well as the following are current, reflect current practice and are consistent with and in compliance with all standards and regulations: Medical Staff By-Laws, Threshold Criteria, Rules, Regulations, and Joint Commission. Audits, assesses, procures, implements, effectively utilizes and maintains practitioner/provider credentialing processes and information systems (e.g., files, reports, databases) by analyzing the needs and resources of medical services/credentialing. Collaborates with Hospital entities, schools, etc., for affiliations and employment verifications. Responding to queries from outside organizations and from within regarding physician credentials for all contracted Providers. Obtain signatures from departmental section and chiefs when credentialing process is complete. Performs and coordinates provider relinquishments with system administrators. Verifies supervising physicians for all Allied Health Professionals with the Composite Medical Board. Respond and assist the quality department review of focused and ongoing professional peer evaluation (FPPE, OPPE) and other items as needed. Perform delegated credentialing for providers outside of the hospital, such as Urgent Care/Youth Care. Visit physicians’ offices when necessary to obtain signatures. Assist Chief Medical Officer, Compliance Department and Medial Staff Director with preparing reports, special projects, and correspondence when needed.

KNOWLEDGE, SKILLS & ABILITIES:

• Undergraduate degree from regionally accredited academic institution in business or healthcare related field and three to five years experience in Medical Staff Services or combination of education and/or experience preferred.
• Ability to review, research and make sound decisions with the results found during the discovery process of of Medical Staff candidates.
• Ability to communicate in a professional manner while bringing forth findings, discrepancies, and/or concerns with candidates’ files in regards to credentialing with the Director of Medical Staff Services, Chief Medical Officer, Chief of Staff and Department Chiefs.
• Medical terminology knowledge preferred and proficient computer skills required such as Microsoft Word, Excel and Outlook.
• CPMSM or CPCS Certification obtained after three years of assuming role of Credentialing Coordinator.
• Considerable mental effort, ability to draft and prepare minutes, correspondence and reports.
• Ability to work independently and prioritize projects.
• Impeccable integrity and ethics.
• Excellent critical thinking skills and communications both oral and written.
• Exceptional organizational skills with attention to detail and accuracy.
• Research bylaws and legal guidelines.
• Ability to de-escalate grievances of visitors and physicians and use sound judgment when dealing with stressful situations.
• Competency in accelerated PC use and required tools.

WORKING CONDITIONS- ADA INFORMATION:

Office setting. Safe working environment, possibility of irregular work hours upon request. Perhaps some discomfort due to noise and crowded conditions. A moderate amount of stress at times. Involves sitting, standing, and bending.