Primary responsibility for the implementation of the Medical Staff Credentialing and Privileging System. Coordinates all aspects of the medical staff credentialing process for new appointments, reappointments and privileging. Monitors all aspects of the process to ensure compliance with regulatory and Joint Commission standards and Medical Staff Bylaws.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Accurately enters and edits data in the credentialing and privileging system. Ensures turn-around-time throughout the credentialing and privileging process as defined in the Medical Staff Bylaws
- Initiates and follows through on all aspects of credentialing and privileging including the initial and re-credentialing process for all practitioners. Able to run database queries and reports to support efficiencies and prioritization of workflow
- Coordinates the processing of incoming applications for initial appointment, and reappointment. Reviews applications thoroughly and enters data in the automated database. Reviews data for accuracy and integrity
- Ensures completion of primary source verification of practitioner’s background through the use of on-line systems, written correspondence, telephone inquiries and printed reference guides, rosters and reports.
- Provides assistance and determines resolution to practitioner issues and/or triages appropriately, via verbal/written communication in response to both internal and external customers. Identifies and responds pro-actively to issues and concerns assuring complete solutions in a timely manner. Identifies and evaluates for potential red flags and works in collaboration with the Supervisor to determine next steps
- Ensures FPPE process is completed for all Medical Staff members following initial appointment and for those exercising new privileges; performs analysis of report data.
- Secures OPPE reports to be utilized in the credentialing and privileging process; performs analysis of report data
- Responsible for preparation of materials and files for presentation and review by the Credentials Committee. Provides back-up support to the Lead Credentials Coordinator related to credentialing and privileging action and/or information items presented to the credentials Committee, Medical Executive Committee and Board of Trustees; support includes, but is not limited to: preparation of meeting agendas, preparation of meeting minutes, preparation of packets and ensuring follow-up to all action items
- Follows through with notification to the Medical Staff Member after Board of Trustees approval of initial appointment, and reappointment to the Medical Staff. Notifies AAMC staff via Outlook of initial appointment of Medical Staff members or changes in Medical Staff Members privileges.
- Performs expedited credentialing as directed by Lead Credentials Coordinator. Ensures that all licensure, insurance and certification requirements are current. Facilitates on boarding of all new members of the Medical Staff.
- High school diploma. Associate degree preferred.
- Excellent organizational, verbal and written communication skills required.
- Must be proficient in MS Office Suite (Word, Excel, Access, Outlook) and Internet/Web. Minimum of two (2) years Supervisory/Lead experience preferred.
- Demonstrated ability to delegate tasks and ensure accuracy of tasks.
- Three (3) to five (5) years related work experience in a Medical Staff Office or hospital credentialing strongly preferred.
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification by the National Association of Medical Staff Services is strongly preferred.
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands –
Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.