Credentialing Specialist - Main Medical Staff Office - Full Time - Days

Job Description Responsible for coordination and preparation of medical staff functions; prepares for committee meetings, takes minutes, processes and distributes appropriate correspondence and assists with the development, planning and implementation of the credentialing and privileging process in addition to the analysis of each file upon completion. Assists in compliance with accrediting and regulatory agencies (Joint Commission and NCQA) in regard to credentialing and privileges while developing and maintaining a working knowledge of statutes and laws. Ensures that all expirables are reviewed, obtained and managed on a monthly basis according to the rules and policies. Maintains the confidentiality of all business/work and medical staff information. Assists in managing the flow of information between medical staff services, Credentials Committee, MEC Committee, medical staff leadership, and Chief Medical Officer. Manages the FPPE process and the integration of OPPE during reappointment. Responsibilities Coordinate the credentialing activities of the Medical Staff and Allied Health Staff, in accordance with the Medical Staff Bylaws, Credentialing Policies and Procedures of The Christ Hospital (TCH) as well as federal and state law, regulatory and accrediting agencies: Upon receipt of applications (initial and reappointment), determine if the application meets criteria and whether to initiate the verification process and documentation, according to policies. Initiate and prepare all required primary source documentation such as AMA and NPDB, etc.; and follow‑up as necessary with providers. Monitor information collection and perform cognitive analysis of all information received; evaluate adequacy and quality, pursue additional information as needed. Coordinate, perform and maintain a tracking system for the process to ensure continuous processing of applications, reporting to Manager as needed. Upon completion of the credentialing process, update all relevant files and listings, credentialing database per policies and procedures and file credentialing files accordingly; ensure clinical privileges are available online for TCH staff to ensure providers are practicing within their scope of privileges. Prepare written notification of Board action to appropriate personnel/practitioners. Initiate Focused Professional Practice Evaluation and assist with the Ongoing Professional Practice Evaluation for practitioners according to policy and procedures. Assist department directors or section chiefs to establish criteria for privileging. Initiate and maintain proctoring of applicants as required with follow‑up. Provide administrative support to Credentials, General Staff and other Medical Staff committees and departments of TCH as directed: Attend meetings. Provide meeting minutes and maintain minutes history. Notify members of meetings. Prepare meeting agenda/handouts, and follow‑up to include coordination of actions taken. Provide coverage for the Medical Executive Committee and others as directed. Process requests for temporary privileges and monitor all follow‑up, according to policies and procedures: Communicate relevant information to applicant and appropriate hospital personnel. Distribute appropriate paperwork. Establish and maintain necessary files. Process requests for additional privileges and monitor all follow‑up, according to policies and procedures: Upon receipt of additional privilege application, initiate the verification process and documentation, according to policies. Initiate and prepare all required primary source documentation, including NPDB, etc.; and follow‑up as necessary with providers. Maintain a tracking system for the process to ensure continuous processing of applications, reporting to Manager as needed. Upon completion, update all relevant files and listings, credentialing database per policies and procedures and file credentials accordingly; ensure clinical privileges are available online for TCH staff. Prepare written notification of Board action to appropriate personnel/practitioners. Communicate relevant information to applicant and appropriate hospital personnel. Distribute appropriate paperwork. Establish and maintain necessary files. Initiate FPPE for all additional privileges. Process requests for one‑time privileges, visiting physicians and/or student observers. Initiate primary source verification if applicable. Maintain a tracking system for the process to ensure continuous processing of applications, reporting to Manager as needed. Upon completion, obtain appropriate signatures for privileges. Communicate relevant information to applicant and appropriate hospital personnel. Distribute appropriate paperwork. Establish and maintain necessary files. Coordinate verification of professional liability coverage, medical licensure, board certification, BLS, ACLS, ATLS, NRP certifications and DEA certification as required. Obtain updated PPD and annual AHP evaluations. Assist with the coordination of annual dues process. Credentialing/Database management: Ensure the data entered into the credentialing database is efficient and accurate. Handle confidential materials; maintain medical staff credentialing files, both electronic and hard copy, keeping them orderly. Assist with special credentialing projects. Assists customers in the absence of the Credentialing Assistant and/or Administrative Assistant. Assist with Joint Commission accreditation preparation, as necessary. Assist with coordination of yearly on‑call schedule preparation and coordination of Department Director election every two years. Coordinate preparation and distribution of new committee roster every two years and yearly master calendar. Assist with verifications of medical staff membership and clinical privileges of providers from other healthcare facilities. Assist in coordination of medical staff events and functions and other duties assigned. Qualifications KNOWLEDGE AND SKILLS: EDUCATION: Associate’s Degree preferred or equivalent combination of education and related experience. YEARS OF EXPERIENCE: Minimum of three years in a healthcare setting performing credentialing, privileging, and medical staff services functions required. REQUIRED SKILLS AND KNOWLEDGE: Applicant must have good verbal, written, and telephone communication skills. Must be able to multi‑task, have attention to detail, and have strong interpersonal skills. Must work independently, exercise independent judgment regarding credentialing and privileging, define problems, prioritize issues, and develop and implement solutions. Must be a self‑starter who functions well in a team, demonstrates leadership, reliability, attendance, professional appearance, and commitment to quality improvement programs. Must have strong computer experience with database management, Microsoft Office, and Windows applications. Must have experience with Joint Commission and other healthcare regulatory bodies. LICENSES & CERTIFICATIONS: CPCS or CPMSM preferred. #J-18808-Ljbffr