Credentialing Specialist

Full-Time Credentialing Specialist

UPMC Horizon-Shenango Valley is looking for a Full-Time Credentialing Specialist to support its Medical Staff Services team! The position requires a detail-oriented, learning focused and organized individual who ideally has prior credentialing/medical terminology experience.

Join our great team in its important mission serving our community ensuring that our providers provide the highest quality care to our community. This position is daylight shifts only (8 hrs.), Monday - Friday starting around 7:30am but some flexibility. No weekend or holiday responsibility is required for this role.

Travel to support UPMC HorizonGreenville and UPMC Jameson will be required as needed following the completion of initial training at UPMC Jameson.

Purpose: Provide all necessary appointment, reappointment, privileging and re-privileging information to enable the timely completion of the appointment process. Review initial and reappointment application files to determine completeness and satisfaction of threshold criteria utilizing established criteria and professional judgment for all applicants to the medical staff, and other health professional staff. Work independently in setting priorities and making decisions.

Responsibilities:

• Screen mail each day for requests from other facilities and independently prepare a response for general affiliation requests for physicians and allied health professionals within two business days of receipt.
• Immediately report to Director any collected information which may be adverse to an applicant
• Provide administrative support for all medical staff committees and departments.
• Maintain confidentiality of all credentials and peer review files.
• Respond to hospital/health care affiliation request letters in a timely manner.
• Prepare all files monthly for Credentials Committee review and follow-up on Credentials Committee decisions.
• Establish and maintain excellent relationships and good communication channels with physicians, office staff, and practice administrators.
• Coordinate and maintain the Physician Orientation Manual.
• Closely monitor information collection; cognitive analysis of information received; evaluate adequacy and quality and pursue additional information if necessary for effective and comprehensive peer review decision-making.
• Respond to CVO e-mail requests for physician/allied health practitioner affiliation requests.
• Communicate as necessary electronically or otherwise with outside resources (i.e., State Boards, National Practitioner Data Bank, Credentials Verification Organization CVO, Legal Counsel, etc).
• Assist with special projects (i.e., physician events, physician education, JCAHO, and Department of Health preparation).
• Take responsibility for ensuring the accurate development and maintenance of a comprehensive medical staff member database within MSO credentialing system. Coordinate efforts with the UPMC Health System Credentials Verification Organization (CVO) staff.
• Inform Program Director, Medical Staff Development Director of any files out for signature exceeding 3 working days.
• Provide recommendations for change and assists with follow-through.
• On a monthly basis, coordinate all agenda items to be presented to the Medical Executive Committee and the Credentials Review Committee of the Board.
• Monitor information provided by Central Verification Organization (CVO) to ensure complete and accurate primary source information is provided for practitioner files.
• For those requests seeking clinical recommendations, the incumbent should log the request then forward to the appropriate department for response.
• Coordinate and facilitate both the informal and formal credentialing peer review/recommendation process per established policies and procedures.
• Coordinate clinical privileges with policies, procedures, and practices relative to current regulatory standards.
• Obtain missing information from CVO files if necessary.
• Prioritize to meet deadlines on daily work and special projects.
• Ensure all individuals with clinical privileges provide services within the scope of their training, licensure and individual clinical privileges granted.
• Coordinate the credentialing process for initial appointment and reappointment for the Medical and Allied Health Professional Staff.
• Upon receipt of a completed application and/or reappointment application, initiate information collection, primary source verification, and documentation process per established policies and procedures.
• Maintain a thorough understanding of the standards of the JCAHO, Department of Health, Bylaws, Rules and Regulation of the Medical Staff, and other regulatory agencies as appropriate.
• Process payment requests through supply chain as necessary.
• Take responsibility for ensuring accurate development and maintenance of a medical staff data base within the MSO credentialing system.
• Coordinate efforts to assist with the Medipac assignments and IMS for practitioners.
• Provides OPPE reports by compiling each profile including data entry.
• Closely monitor information collection, cognitive analysis or information received; evaluate adequacy and quality and pursue additional information if necessary for effective and comprehensive peer review decision-making and incorporation into physician
• Assist in oversight of the residents participating at Jameson relative to schedules, housing, educational space and orientation.

Prefer 2 years college level course work. Prefer experience in the medical staff services environment. Require knowledge of accurate record keeping for filing. Require proficiency in Word Windows-based software: Excel, Access and Morrissey's MSO Credentialing Software. Require skill in effective, professional oral and written communications.

Require the ability to relate positively with all levels of the organization with tact, diplomacy and strength. Licensure, Certifications, and Clearances: CPCS preferred. Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran