Credentialing Specialist - Medical Staff Office - FT - Day

Position Status:
Full time
Shift:
First Shift (Days - Less than 12 hours per shift) (United States of America)
Hours per week:
40
Job Information
Exemption Status: Non-Exempt

A Brief Overview
This Credentialing Specialist will assist in ensuring patient safety throughout Stormont Vail Health. This position works with the Medical Staff and Administration ensuring Stormont Vail Health (SVH), SVH Bylaws and other regulations are met through the medical staff and organizational processes. The Credentialing Specialist is responsible for communicating information to the Director, Credentialing Coordinator, Medical Staff and others as appropriate.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• 3 years Experience in a field of primary source verification with focus of credentialing in a healthcare environment or managed care or equivalent experience in criminal or fraud investigations. Required
• 3 years Experience with Microsoft office products including but not limited to; Excel, Word, and PowerPoint. Required
• 3 years Direct health care or managed care experience working with health care professional and/or health care administrative leaders. Preferred
• 2 years Direct credentialing software experience, with a preference to MD-Staff, MD-Stat experience. Preferred

Skills and Abilities

• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, legal, accrediting and regulatory information and medical terminology. (Required proficiency)
• Ability to analytically think. Ability to perform clinical competence evaluations. Able to be flexible and adaptive to timelines and situations. Knowledge of change or database management. Ability to ask questions and to follow instructions/directions. (Required proficiency)
• Confidentiality, Foster team cohesiveness and collaboration & Professional Ethics. Able to build relationships. (Required proficiency)
• Demonstrate excellent writing skills to develop and write business correspondence, reports and procedure manuals accurately and in accordance with recognized standards (grammar, punctuation) for the English language. (Required proficiency)
• Demonstrates respect for all individuals (visitors, peers, customers and team members) and helps create and maintain teamwork within the work environment, which contributes to meeting the goals and objectives of the Medical Staff Services department and reflects the mission and values of Stormont Vail Health. (Required proficiency)
• Exhibit oral communication skills (tact, diplomacy etc.) to represent and respond to information for a broad audience including, but not limited to, managers, physicians, outside regulatory agencies, customers and the public. (Required proficiency)

Licenses and Certifications

• Certified Provider Credentialing Specialist - NAMSS CPCS also accepted. Preferred
• Certified Professional Medical Services Management - NAMSS Preferred

What you will do

• CONDUCTS, PARTICIPATES IN, AND MAINTAINS PRIMARY SOURCE VERIFICATION: Perform outreach to primary sources for practitioners' information. Obtain and evaluate information from primary sources. Perform detailed and thorough review of applications, primary source verifications, and sources provided. Recognize potential discrepancies and adverse information, and independently investigate and validate information from primary source verifications, or other sources. Verify and document expireables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Serve as main point of contact for external queries regarding practitioners' status, providing responses in a timely matter.
• Compile practitioner sanctions, complaints, and adverse data to ensure compliance. Demonstrate an understanding of state and regulatory standards. Demonstrate an understanding of state and regulatory standards in relation to telehealth and credentialing by proxy.
• Complete evaluation of application to determine applicant's initial eligibility for membership/participation. Review application and supporting documents for completeness. Serve as main point of contact for practitioner during application process, providing timely updates and additional information as requested. Determine applicant's initial eligibility for membership/participation based on approved criteria. Compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies. Perform initial or reappointment/re-credentialing for eligible practitioners. Process requests for privileges. Conduct, participate in, and maintain credentialing verification organization (CVO)
• Identify and report to their supervisor adverse actions taken against a practitioner/provider in accordance with applicable law and contractual requirements. Monitor and/or report sanctions and complaints for all practitioners/providers to supervisor. Develop informational/educational documents (newsletters, memos) to communicate critical information regarding organizational programs and policies. Develop and cultivate working relationships with key stakeholders, both internal and external, to ensure appropriate awareness of key issues and decision-making.
• Obtain and assess information from various referral sources. Recognize, investigate, and validate discrepancies and adverse information obtained. Communicates findings and/or resulting actions to Credentialing Specialist, Director, Medical Staff and department peers as appropriate/policy.
• Working knowledge of NCQA, TJC Accreditation standards and SVH Bylaws, etc.., Manage, facilitate and maintain continuing medical education records for practitioners/providers.
• Securely manage information as the single source of truth by effectively navigating database software and maintaining data integrity. Use database software for contracting, training, reporting, as well as integrating with other IT systems.
• Mentor, train and educate others to include department team members and medical staff members on policy, procedures, Bylaws, ...
• Conducts, participates in, and maintains primary source verification, credentialing, privileging, current clinical competency, FPPE and OPPE data and files.
• Complies with State and Federal accreditation standards, regulatory requirements, SVH bylaws, department and SVH policies. Applies all regulations and policies to credentialing duties as necessary.
• Facilitates Medical Staff Functions to include but is not limited to meeting preparation, attendance, transcription of minutes and all other aspects of meetings.
• Maintenance of OPPE, FPPE, expirables to include boards, licenses audits, delineation of privileges and protocals, and collaborative practice agreements.
• Assist with the initial or reappoint/recredentialing for eligible practitoner's, file audits and review and edit of delineation of privileges.

Travel Requirements

• 5%

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Rarely less than 1 hour
• Carrying: Rarely less than 1 hour
• Climbing (Stairs): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Rarely less than 1 hour
• Feeling: Rarely less than 1 hour
• Grasping (Fine Motor): Frequently 3-5 Hours
• Grasping (Gross Hand): Frequently 3-5 Hours
• Handling: Rarely less than 1 hour
• Hearing: Frequently 3-5 Hours
• Kneeling: Rarely less than 1 hour
• Lifting: Rarely less than 1 hour up to 25 lbs
• Operate Foot Controls: Rarely less than 1 hour
• Pulling: Rarely less than 1 hour up to 25 lbs
• Pushing: Rarely less than 1 hour up to 25 lbs
• Reaching (Forward): Rarely less than 1 hour up to 25 lbs
• Reaching (Overhead): Rarely less than 1 hour up to 25 lbs
• Repetitive Motions: Rarely less than 1 hour
• Sitting: Continuously greater than 5 hours
• Standing: Occasionally 1-3 Hours
• Stooping: Rarely less than 1 hour
• Talking: Frequently 3-5 Hours
• Walking: Occasionally 1-3 Hours

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.