Ensures interpretation and compliance with the appropriate credentialing and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database systems and related applications.
ESSENTIAL FUNCTIONS AND BASIC DUTIES
Supervisory-Specific Performance Expectations, Duties, and Responsibilities:
Position-Specific Performance Expectations, Duties, and Responsibilities:
- Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
- Conducts thorough background investigation, research, and primary source verification of all components of the applicant’s file.
- Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
- Prepares credential files for completion and presentation to MRH and Medical Staff Committees, ensuring file completion within specified time periods.
- Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
- Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
- Assists with internal provider file audits.
- Monitors the initial, reappointment, and expired credentials process for all medical staff, Allied Health Professional staff, other health professional staff, and non-employed/delegated providers, ensuring compliance with regulatory bodies as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and contracts.
- Prepares meeting agendas and takes minutes for Medical Staff Committees.
- Utilizes credentialing software to maintain current records, licensures, and certifications.
- Organizes and facilitates the Peer Review process as needed. Maintains Peer Review documents in a locked file.
- Prepares confidential reports for the Medical Executive Committee (MEC).
- Establishes and maintains a professional relationship with all staff to resolve problems, working as a team.
- Functions in a high-volume, multiple-task environment, while producing quality work.
- Prioritizes workload and completes assignments within allotted time.
- Able to work independently and problem-solve.
- Must meet established productivity and quality guidelines.
- Attends all applicable workshops.
- Responsible for monitoring directed indicators.
- Performs other duties as assigned.
Organization-Specific Performance Expectations, Duties, and Responsibilities:
- Demonstrates full commitment to the CHOICE values of MRH and consistently represents the organization in a positive, professional manner.
- Establishes and maintains effective verbal and written communication, fostering positive working relationships with patients, staff, and vendors.
- Adheres to the MRH attire and dress code in accordance with organizational policies and procedures.
- Exhibits initiative and self-motivation; maintains a consistent level of productivity and manages time and responsibilities effectively.
- Completes all required annual education, training, in-services, and licensure/certification updates; actively participates in departmental and organizational meetings or reviews meeting minutes as required.
- Maintains strict patient confidentiality at all times.
- Reports to work punctually and completes assigned duties within established timeframes.
- Actively contributes to departmental and organization-wide performance improvement and continuous quality initiatives.
- Ensures compliance with all regulatory requirements, maintaining adherence to departmental, hospital, state, and federal standards and policies.
- Follows all infection control, safety, and risk management procedures to maintain a safe environment for patients, the public, and staff.
QUALIFICATIONS
- Must be at least 18 years of age (21 for positions requiring driving, with a valid driver’s license).
- Must be legally authorized to work in the United States.
- Must successfully pass a background check.
- Must successfully pass a pre-employment drug screen and breath alcohol test (if applicable).
- Must complete an Employee Health meeting prior to starting employment.
EDUCATION, LICENSURE(S), AND CERTIFICATION(S)
Bachelor’s degree in Business Administration, Healthcare Administration, or related field.
National Association Medical Staff Services (NAMSS) as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
EXPERIENCE
One (1) year of experience directly related to hospital medical staff or managed care credentialing.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
