1. Assists with daily office activities/functions/operations (emails, phones, mail) and coordinates scheduling needs for the Director ensuring that messages are transmitted and responses are made in a timely manner.

2. Serves as a resource for medical staff members regarding medical staff bylaws, rules and regulations, hospital and medical staff policies.

3. Responsible for the full coordination and processing of all aspects of the credentialing as it relates to initial appointments and reappointments for physician and allied health, in accordance with Medical Staff Bylaws, Joint Commission Standards, and State and Federal law. Works in unison with the Director of the Medical Staff Office, Chair of Credentials, CMO, and President of the Medical Staff for any follow-ups as required with respect to appointments, reappointments, off-boarding & privileging. This includes maintenance of the credentialing software, uploading information and running reports.

4. Maintenance of paper Credential Files & scanning of documents into Credentialing Database (including expirables: for all initial appointments, reappointments, changes-in- status, & off-boarding [i.e., Resignations, Withdrawal of Appointments, Non-Reappointments, Retirements/Terminations, Suspensions, etc]).

5. Performs required duties to facilitate in the Medical Center’s FPPE & OPPE processes by working with the Director of Medical Staff Services, CMO and Chairs & Chiefs.

6. Performs required duties with uploading privileges in the Medical Center’s Intranet with privileges as it relates to Initial Appointments and Reappointments (monthly).

7. Runs Board Letters for Initial Appointments, Reappointments, Changes-in-Status (LOA, Low Volume, Resignations, Retirements, Non-Reappointments, Terminations, etc) and sends letters & DOPs via email & if required, via mail.

8. Performs required duties with the Medical Staff Directory and run queries and reports from the Credentialing Database, to ensure Directory is up-to-date on the Intranet (monthly).

9. Attends Medical Staff meetings as required, & assists with agenda and materials, on an on-needed basis. Provides supportive services to the Director of Medical Staff Services, Chair Credentials, CMO, & President of the Medical Staff in fulfilling these requirements.

10. Interfaces with all levels of employees and the general public, whereby, promoting professionalism of the department.

11. Maintains established departmental policies and procedures, objectives, quality assurance program, safety, environmental, and infection control standards.

12. Customer Service: respect, flexibility, knowledge, confidence, professionalism, pleasant attitude, patience and helpfulness. All responses should be timely, professional, caring, and respectful in accordance with Customer Service Performance expectations.

Position may be able to be 100% remote for the right candidate

Primary Purpose

Credentialing Specialist supports the credentialing program that implements federal, state, and local regulatory and TJC/NCQA accreditation requirements. Ensures that all practitioners are evaluated and credentialed upon application to Membership and/or Privileges to Parkland Health & Hospital System Medical Staff or non-medical staff. Gathers, analyzes, and report provider data for the provider directory, ongoing reviews, billing needs, and member support. Communicates with practitioners and practitioner groups to answer their questions and concerns or direct to the proper department. Assists with oversight audits of Practitioners.

Minimum Specifications

Hybrid/Remote

Education

Some College preferred

Experience

Managed care or credentialing experience preferred. Experience with TSCA, TJC, NCQA accreditation, National Provider Data Bank (NPDB) is preferred. Experience with federal, state and/or local managed care statutes is preferred.

Certification/Registration/Licensure

Prefer certification by the National Association Medical Staff Services (NAMSS).

Skills or Special Abilities

Working knowledge of general office practices and software applications (MS Office) and database management. Demonstrated understanding of credentialing policies and procedures and training program requirements, as well as accreditation and regulatory requirements relating to the medical staff, specifically Joint Commission and NCQA. Organizational skills required to handle voluminous influx of credentialing applications and to prioritize tasks to work efficiently and meet cyclical and multiple deadlines. Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision. Analytical skills necessary to determine whether correct and complete information was provided on applications. Meticulous attention to detail. Interacts with diverse groups of people within the Health System and with outside agencies. Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies. Handles sensitive and confidential situations/information, with a high degree of tact and diplomacy. Effective interpersonal skills and demonstrated written and verbal communication skills are necessary to interact with providers and both external and internal customers. Skilled in interpreting, analyzing, and providing recommendations regarding data accuracy and data collection needs and processes. Excellent planning, organization, time management, and documentation skills.

Responsibilities

Builds and maintains relationships with internal, and external credentialing partners including physicians and hospital leadership. Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. May conduct primary source verification for initial/re-credentialing applications in accordance with defined workflows and established policies and procedures. Responsible for the follow-up on missing data and/or discrepancies in accordance with established time frames and based on knowledge of general credential processes and needs of clinical assignment. As responses to queries received and information entered in database, compares information received with information provided by applicant to ensure accuracy and completeness. Imports all applications from the online application portal in accordance with policy for data standardization. Maintains integrity of the credentialing database and all practitioner records. Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of imported data as well as data that may be entered manually. Serves as a liaison with MSH affiliates and their medical staff administration departments, MMG and MFC, which includes providing effective and timely communication as the status of the application and any issues that may be identified. Other duties as assigned.

Job Accountabilities

Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Full-time

Comanche County Memorial Hospital - Lawton, OK 73505

Compensation: Based Experience

DEFINITION:

Performs credentialing duties for hospital’s medical staff and allied health staff, performs complex secretarial work, maintains expertise in computer/secretarial skills.

EDUCATION:

Must be a high school graduate or equivalent.

MINIMUM QUALIFICATIONS:

Must have completed basic computer course as well as have expertise in Microsoft Office Suite.

PREFERRED QUALIFICATIONS:

A minimum of two years experience as a Credentialing Coordinator or Medical Staff Secretary is preferred.

A successful Medical Staff Services Assistant (“Assistant”) will be professional, polite, attentive and accurate. They should always be prepared and responsive, willing to meet each challenge directly. This person must be comfortable with computers, general office tasks, and excel at both verbal and written communication. Most importantly, this person should have a genuine desire to meet the needs of others.

This person assists with the coordination of medical staff activities, performs clerical and delegated administrative job duties and acts as a liaison between the community, Medical Staff, nursing staff, Administration and related health agencies within parameters established by the organization.

This position reports to the Director and manages the day-to-day operations of the Medical Staff Services Office. Works collaboratively with the Manager of Provider Enrollment, Medical Staff Leadership, and Hospital Leadership to organize and maintain systems that coordinate the credentialing and re-credentialing process for all Lahey Hospital and Medical Center (LHMC) providers.

Essential Duties & Responsibilities including but not limited to:

1. Collaborates with the system CVO, Hospital Leadership, and Legal Counsel in assisting providers with the application process for timely appointment, reappointment, clinical privileges, and expirables in accordance with Medical Staff Bylaws, Rules and Regulations, hospital policies and procedures and in accordance with The Joint Commission (TJC) and National Council for Quality Assurance (NCQA) requirements and other state and federal regulatory agencies as required.
2. Manages the timely credentialing, re-credentialing, and clinical privileges of LHMC providers
3. Manages coordinates the timely submission of information for the delegation audits by insurance plans
4. Oversees the integrity, accuracy, and completeness of database entries
5. Oversees and manages the maintenance of electronic provider records as required
6. Collaborates with physician leadership in the development of new, or revision of, current privilege forms.
7. Prioritizes work and provides guidance and direction to Medical Staff Office coordinators and on occasion of other staff assigned to assist with special projects.
8. Conducts regular MSO staff meetings.
9. Responsible for the hiring, training, mentoring, ongoing professional development, and evaluations of all team members.
10. Accountable for all departmental budgetary matters including variances.
11. Frequently assesses the productivity of departmental and develops business strategies to ensure effective business operations.
12. Responsible for the development of new policies, review and revision of current policies, and the compliance thereto.
13. Coordinates all aspects of the Credentials Committee, Medical Executive Committee, Medical Staff Appointment Committee of the Board, and other medical staff committees (as assigned) to include the agenda, minutes, reports, and any required follow-up.
14. Oversees, coordinates and manages the FPPE and OPPE process.
15. Maintains a working knowledge of and compliance to The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) TJC and NCQA standards as well as of the organization’s Medical Staff Bylaws, Rules and Regulations, and applicable medical staff and hospital policies.
16. Exemplifies a culture of excellence and customer service in all processes with all internal and external customers and all external representation of Lahey Hospital & Medical Center.

Organizational Requirements:

1. Maintain strict adherence to the Lahey Hospital & Medical Center Confidentiality policy.
2. Incorporate Lahey Hospital & Medical Center Standards of Behavior and Guiding Principles into daily activities.
3. Comply with all Lahey Hospital & Medical Center Policies.
4. Comply with behavioral expectations of the department and Lahey Hospital & Medical Center.
5. Maintain courteous and effective interactions with colleagues and patients.
6. Demonstrate an understanding of the job description, performance expectations, and competency assessment.
7. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
8. Participate in departmental and/or interdepartmental quality improvement activities.
9. Participate in and successfully completes Mandatory Education.
10. Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education: Completion of a graduate or undergraduate degree in healthcare or related field, or equivalent related experience commensurate with a graduate or undergraduate degree.

Licensure, Certification & Registration: Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Staff Management (CPMSM) strongly preferred or willingness to achieve said certifications within 5 years.

Experience: At least two years management experience working in a Medical Staff Office or CVO

Skills, Knowledge & Abilities:

• Knowledge of credentialing database system(s) and associated applications strongly preferred.
• Excellent interpersonal and communication skills
• Ability to work under minimal supervision and to adapt quickly to changes within the environment.
• Knowledge of MD-Staff credentialing software

FLSA Status: Exempt

GENERAL SUMMARY The Credentialing Specialist I reports to the Director of Professional Staff and is responsible for supporting departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and primary source verifications, as well as ensure compliance with Bylaws and Rules and Regulations; State and Federal requirements; and accreditation standards. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility. This individual may also be mentored by any Credentialing Specialist II within the department. Actively seeks to promote and maintain, through interactions with others within and outside the department, a positive, professional, team-oriented and service conscious environment that contributes to the goals of the department and reflects the values and mission of CHKDHS.

ESSENTIAL DUTIES AND RESPONSIBILITIES

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 applications, primary source verifications, or other sources. Verify and document expirables 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.

CONDUCTS, PARTICIPATES IN, AND MAINTAINS CREDENTIALING AND PRIVILEGING: Complete evaluation of application to determine applicant’s initial eligibility for membership/participation, based on approved criteria. Review application and supporting documents for completeness. Uniformly apply clearly defined credentialing or privileging processes to all providers. Evaluate credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested privileges, membership, and/or plan participation. Serve as main point of contact for practitioner during application process, providing timely updates and additional information as requested. 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).

CONDUCTS, PARTICIPATES IN, AND MAINTAINS CURRENT CLINICAL COMPETENCY EVALUATIONS AND PEER REVIEW: Obtain and assess information from various referral sources. Recognize, investigate, and validate discrepancies and adverse information obtained. Communicates findings and/or resulting actions to supervisor and department peers (CS II).

COMPLIES WITH ACCREDITATION AND REGULATORY STANDARDS: 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.

MANAGES COMPLIANCE WITH STATE AND FEDERAL ACCREDITATION STANDARDS AND REGULATORY REQUIREMENTS: Facilitate efficient and cost-effective due process that complies with an organization’s fair hearing and appeals policy as well as applicable legal and regulatory requirements. 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.

MANAGES DEPARTMENTAL OPERATIONS: Maintain credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders. Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) as outlined by the department. FACILITATES MEDICAL STAFF FUNCTIONS: Manage and maintain compliance records of periodic and/or annual provider requirements such as vaccinations, annual education, etc. Facilitate and attend, as assigned, committee, general staff and department meetings. Secure meeting rooms, arrange for catering and special equipment needs for above meetings. Prepare minutes of meetings for dissemination to members and others among senior leadership. Record conclusions and recommendations accurately to substantiate actions taken by departments or committees. Maintain and protect the confidential records of proceedings which may be required in subsequent internal investigations and/or legal disputes.

ANALYZES AND MANAGES DATA Securely manage information as the single source of truth by effectively navigating database software and maintaining data integrity. Use database software for training, reporting, as well as integrating with other IT and revenue systems.

LICENSES AND/OR CERTIFICATIONS CPCS and/or CPMSM certification by the National Association Medical Staff Services (NAMSS) preferred.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS High school diploma or equivalent required. College degree preferred. At least 3 years previous hospital credentialing experience preferred. Proficiency in credentialing software required, MD-Staff preferred. Proficiency in Microsoft Office products required. Working knowledge of DNV and CMS accreditation standards related to credentialing required. Basic statistical knowledge and experience required. Analytical, problem-solving, organizational and prioritizing skills required. Strong oral, written and interpersonal communication skills required. Effective meeting management skills required.

WORKING CONDITIONS Fast-paced, extremely busy office environment where interruptions are frequent. Works in a normal office environment with little exposure to excessive noise, dust, temperature and the like.

PHYSICAL REQUIREMENTS Click here to view physical requirements.

GENERAL SUMMARY The Credentialing Specialist II reports to the Director of Professional Staff and is responsible for supporting departmental activities to ensure quality in conducting, maintaining, and communicating physician credentialing, privileging, and primary source verifications, as well as ensure compliance with Bylaws and Rules and Regulations; State and Federal requirements; and accreditation standards. Serves as a resource to, and collaborates with, others to advance the quality of practitioners and patient safety of the facility. Acts as a mentor to Credentialing Specialist I personnel within the department. Actively seeks to promote and maintain, through interactions with others within and outside the department, a positive, professional, team-oriented and service conscious environment that contributes to the goals of the department and reflects the values and mission of CHKDHS.

ESSENTIAL DUTIES AND RESPONSIBILITIES

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 applications, primary source verifications, or other sources. Verify and document expirables 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.

CONDUCTS, PARTICIPATES IN, MAINTAINS AND MANAGES THE CREDENTIALING AND PRIVILEGING PROCESS: Complete evaluation of application to determine applicant’s initial eligibility for membership/participation, based on approved criteria. Review application and supporting documents for completeness. Uniformly apply clearly defined credentialing or privileging processes to all providers. Comply with internal and external requirements related to verifying the status of all practitioner/provider expirables (e.g. licenses, certifications) by querying approved sources and recommending action(s) to ensure compliance. Evaluate credentialing/privileging requests and evidence of education, training, and experience to determine eligibility for requested privileges, membership, and/or plan participation. Serve as main point of contact for practitioner during application process, providing timely updates and additional information as requested. 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).

CONDUCTS, PARTICIPATES IN, AND MAINTAINS CURRENT CLINICAL COMPETENCY EVALUATIONS AND PEER REVIEW: Obtain and assess information from various referral sources. Recognize, investigate, and validate discrepancies and adverse information obtained. Coordinate an appropriate evaluation of gathered data by physician leaders (potentially for assignment to officers, chairs, chiefs for follow/up). Communicates findings and/or resulting actions to supervisor and department leadership.

COMPLIES WITH ACCREDITATION AND REGULATORY STANDARDS: Obtain and evaluate practitioner sanctions, complaints, and adverse data to ensure compliance. Participate in an ongoing assessment of governing documents (bylaws/rules and regulations/policies and procedures) to ensure continuous compliance. Participate in audits of delegated credentialing entities (Children’s Health Network). Participate in surveys and audits of regulatory and accreditation agencies or organizations (DNV, etc.). Demonstrate an understanding of state and regulatory standards. Demonstrate an understanding of state and regulatory standards in relation to telehealth and credentialing by proxy.

MANAGES COMPLIANCE WITH STATE AND FEDERAL ACCREDITATION STANDARDS AND REGULATORY REQUIREMENTS Facilitate efficient and cost-effective due process that complies with an organization’s fair hearing and appeals policy as well as applicable legal and regulatory requirements. Identify and report to facility leadership adverse actions taken against a practitioner/provider in accordance with applicable law and contractual requirements. Oversee the monitoring and reporting of sanctions and complaints for all practitioners/providers to inform recommend action by organizational leadership. Oversee the development and dissemination of 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.

MANAGES DEPARTMENTAL OPERATIONS: Maintain credentialing database continuously and consistently to ensure that accurate and current information is available to all stakeholders. Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, databases) as outlined by the department.

FACILITATES MEDICAL STAFF FUNCTIONS: Collaborate with management to develop and update initial and annual/ongoing provider education to ensure staff’s ongoing competence. Facilitate and attend, as assigned, committee, general staff and department meetings. Secure meeting rooms, arrange for catering and special equipment needs for above meetings. Prepare minutes of meetings for dissemination to members and others among senior leadership. Record conclusions and recommendations accurately to substantiate actions taken by departments or committees. Maintain and protect the confidential records of proceedings which may be required in subsequent internal investigations and/or legal disputes. Conduct and execute special projects as required. Assist the Director in the creation and development of policies and procedures for the Professional Staff and internal operation.

ANALYZES AND MANAGES DATA: Organize information and data to identify/explain trends, problems, and their causes. Compare, contrast, and combine data to determine underlying issues. Identify associations between seemingly independent problems or events to recognize trends, problems, and possible cause-effect relationships. Securely manage information as the single source of truth by effectively navigating database software and maintaining data integrity. Use database software for training, reporting, as well as integrating with other IT and revenue systems. Evaluate, analyze, and recommend software upgrades, changes, interfaces, and modules.

LICENSES AND/OR CERTIFICATIONS CPCS and/or CPMSM certification by the National Association Medical Staff Services (NAMSS) required, or obtained within three years of hire or eligibility as determined by NAMSS.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS High school diploma or equivalent required. College degree preferred. At least 10 years previous hospital credentialing experience preferred. Proficiency in credentialing software required, MD-Staff preferred. Proficiency in Microsoft Office products required. Working knowledge of DNV and CMS accreditation standards related to credentialing required. Basic statistical knowledge and experience required. Analytical, problem-solving, organizational and prioritizing skills required. Strong oral, written and interpersonal communication skills required. Effective meeting management skills required.

WORKING CONDITIONS Fast-paced, extremely busy office environment where interruptions are frequent. Works in a normal office environment with little exposure to excessive noise, dust, temperature and the like.

PHYSICAL REQUIREMENTS Click here to view physical requirements.

POSITION SUMMARY Coordination of credentialing, re-credentialing, Medical Staff. Committee activities, peer review and other Medical Staff functions as needed. Responsible for providing support to the medical and allied health staff with credentialing and privileging activities, committee activities, assuring compliance with regulatory and accreditation standards, SARH bylaws, rule and regulations, and other related MSS functions as needed.

MINIMUM QUALIFICATIONS

Education: High School Diploma or GED; prefer Associate’s degree or equivalent training and experience.

Experience: This individual has a minimum of 3 years experience in a hospital environment involving medical staff related functions. The applicant shall have a minimum of three (3) years Medical Staff office and/or credentialing experience.

Knowledge and Skills: Medical Staff functions, i.e. Credentialing process, privileging, and peer review; working knowledge of Joint Commission, CME and Title 22 standards for Medical Staff functions; Medical Staff Bylaws/Rules & Regulations as well as Robert’s Rules of Order and of credentialing, governance (Bylaws, Rules and Regs), and privileging.

License/Certifications:CPCS certification preferred. CPSC or CPMSM NAMSS certification preferred.

Equipment: Computer (Word, Excel) medical staff database; MD-Staff experience preferred.

Physical Requirements: Must be able to perform the essential physical requirements of the job.

Position is 95% remote, but applicants must be located 2 hours from Dallas, TX

Primary Purpose

Supports the credentialing program that implements federal, state, and local regulatory, Joint Commission and NCQA accreditation requirements. Ensures that all practitioners and facilities are evaluated upon entry into the MSPS Database, as required, and conducts an ongoing review of the providers. Gathers, analyzes, and report provider data for the provider directory. Communicates with providers and provider groups to answer their questions and concerns or direct to the proper department. Assists with oversight audits of provider data.

Minimum Specifications

Education

Bachelor’s degree is required.

Experience

Three (3) years of managed care or credentialing experience. Two (2) years of experience in provider data management. Experience with CAQH, Texas Association of Health Plans (TAHP), NCQA accreditation, Aperture, or National Provider Data Bank (NPDB) is preferred. Experience with federal, state and/or local managed care statutes is preferred.

Equivalent Education and/or Experience

May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above. Certification/Registration/Licensure

National Association Medical Staff Services (NAMSS) certification is preferred. Provider Enrollment specialist Certificate (PESC) is preferred.

Skills or Special Abilities

Advanced proficiency in Microsoft Excel to include VLOOKUP, creating complex function and equations. Proficiency in Adobe Pro and Microsoft Outlook. Experience using SharePoint is preferred. Strong interpersonal, problem solving and relationship building skills with positive attitude and demeanor. Ability to take initiative to research and form conclusions independently. Ability to manage multiple deadlines and time constraints in a fast-paced environment. Demonstrated ability to collaborate effectively and work as part of a team including internal and external stakeholders. Ability to perform detail work efficiently and with a high degree of accuracy. Clear and professional verbal and written communication skills with the ability to clearly explain complex processes. Skilled in interpreting, analyzing, and providing recommendations regarding data accuracy and data collection needs and processes. Excellent planning, organization, time management, and documentation skills.

Responsibilities

Builds and maintains relationships with external vendors and credentialing partners including which may include CAQH, Aperature & Texas Association of Health Plans. Administrates reports in external database portals & analyze data, confirm accuracy, and present to internal department. Assists with the oversight of the delegated provider and facility’s data. Gathers, analyzes, and reports provider data to internal and external customers. Ensures that all practitioners and facilities data elements are evaluated upon entry into the MSPS database and conducts an ongoing review of the provider data. Identifies opportunities for improvement through the audit process and provides recommendations. Accurately tracks, reports, and follows up on the status of credentialing applications. Maintains a strict degree of confidentiality in all areas relating to provider credentials, status, and provider personal information. Familiar with state specific all department policies and procedures. Assist with miscellaneous audits projects throughout the year as required. Communicates with Leadership regarding any or all credentialing delays or issues. Other duties as assigned.

Job Accountabilities

Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Nearest Major Market: Dallas Nearest Secondary Market: Fort Worth Job Segment: Healthcare Administration, Patient Care, Data Management, Healthcare, Data

Position is 95% remote, but applicants must be located 2 hours from Dallas, TX

Primary Purpose

Coordinates administrative support services for the Medical Staff and assures that all credentialing and accreditation processes are completed, and that only qualified and competent physicians and practitioners are appointed and reappointed to the hospital staff.

Minimum Specifications

Experience

Must have three years of Medical Staff/Credentialing experience.

Equivalent Education and/or Experience

May have an equivalent combination of education and experience to substitute for the experience requirements.

Certification/Registration/Licensure

Prefer certification by the National Association Medical Staff Services (NAMSS) as a Certified Professional in Medical Services Management (CPMSM) or a Certified Provider Credentialing Specialist (CPCS).

Skills or Special Abilities

Must have excellent verbal and written communication skills and be able to communicate effectively with Medical Staff and hospital personnel. Must have a working knowledge of hospital accreditation, medical/allied staff credentialing, privileging, appointment, and licensure requirements. Must be familiar with personal computer, word processing, data processing and spreadsheet usage.

Responsibilities

Prepares, analyzes, and processes licensing and credentialing documents for hospital medical staff privileges application and reapplication to assure that qualified and competent physicians and practitioners are appointed and reappointed to the hospital staff, while providing optimal services to internal and external customer. Prepares applications for internal and external audit. Processes applications through direct source verifications, i.e., National Practitioner Data Bank and Federation of State Medical Boards queries to assure information provided and/or requested is accurate and complete. Processes requests for, and monitors duration of, temporary privileges in accordance with departmental policies and procedures and medical staff policies, bylaws, rules, and regulations to ensure that only qualified practitioners are providing care in the hospital. Maintains open communication to be a resource to practitioners, medical boards, etc. for issues of sensitivity, problem solving, or confidentiality and maintains and updates confidential files on all medical staff members regarding their board certification, attendance, CME activities, publications, committee participation, liability insurance, etc. while maintaining a positive working relationship with all internal and external contacts. Generates reports, demographics, statistical information, appointments, staff roster, etc. to satisfy multi-external agency requests and various departmental requests that support the missions, goals, and objectives of the hospital and Parkland. Attends the medical staff committee meetings as assigned by the director and prepares the agenda for each committee meeting for review and approval by the committee chair, records committee minutes; initiates follow-up action as dictated by the committee minutes. Closely monitors information collection, evaluates adequacy of quality data and information, request additional information if necessary, for effective and comprehensive peer review decision-making.

Job Accountabilities

Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Nearest Major Market: Dallas Nearest Secondary Market: Fort Worth Job Segment: Healthcare Administration, Patient Care, Administrative Assistant, Medical, Healthcare, Administrative

Full Job Description Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We’re honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don’t inquire about immigration status because we simply don’t need to know. If you come to us, we will treat you like any other patient.

As we grow our team, we are looking for individuals who believe the patient is always #1.

Why work for us?

Competitive pay which matches your abilities and experience Health coverage for you and your family Generous number of vacation days per year A robust wellness plan and health club discounts Continuing education assistance to grow and further your talents 403(B) plan with company matching

Intrigued? We’d love to hear from you! Please review the job details below and then click “apply.”

We're looking for someone to join our team as a Credentialing Coordinator who:

Initiate, coordinate, monitor and maintain the credentialing and re-credentialing of all practitioners and allied health staff employed and/or contracted with Clinica Sierra Vista. Will also assist to perform duties regarding various managed-care activities.

Essential Functions:

Completion of health care professionals credentialing and re-credentialing applications including the privileging and re-privileging for all Practitioners and allied health staff employed/or contracted with Clinica Sierra Vista. In addition, responsible for the completion of the credentialing and re-credentialing of Other Licensed and Certified Practitioners. Initiates and conducts primary source verification of practitioner’s background, education/training and malpractice history through the use of online systems, written correspondence, telephone inquiries and other acceptable credentialing methods. Identifies and evaluates potential red flags and works in collaboration with the credentialing manager to determine next steps. Performs ongoing monthly and quarterly compliance reporting. Analysis of report data and state board sanction information in compliance with regulatory on-going monitoring requirements. Is responsible for preparation of materials and files for presentation and review by credentialing committee. Perform data management and reporting from credentials database. Collaborates with inter-departmental peers, including Quality Management and Operations to identify and implement best practices and to ensure an integral, timely, and consistent product. Works with Human Resources/Operations department/Recruitment to ensure timely credentialing of new health care professionals prior to employment. Other duties as required. Please see attachment for full job description. You'll be successful with the following qualification:

Any combination equivalent to: An associate’s degree AND one year of credentialing experience in a managed care setting or experience in the medical field with a thorough understanding of credentialing and privileging. Background of strong administrative skills will also be considered. Certified Provider Credentialing Special (CPCS) desired. Working knowledge of accreditation standards, including Joint Commission, NCQA, HRSA and CMS preferred. Knowledge of MD Staff (ASM) preferred. Proven ability to function independently with minimal direct supervision required. Strong organizational and communication skills required. Excellent oral and written communication, interpersonal and computer skills required. Proficient in Microsoft Office Suite (Outlook, Word, Excel). Comfortable extracting and formatting data for ad hoc report requests. Attention to detail a must. Confidentiality required. Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they’re counting on us.

Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!

Job Description Details

Department: Medical Affairs Schedule: Monday - Friday, 8am to 5pm Hospital: St. Vincent's Location: St. Vincent's Ridge Park

Benefits

Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community

*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics.

Responsibilities

Manage the daily operations of the medical staff services area.

Serve as a principal resource for ensuring compliance with internal and external standards, including accrediting and regulatory agencies, and for guiding decision-making/dispute resolution processes. Participate as team member and leader in quality improvement activities related to medical staff and medical staff services, including process improvement, development of policies and procedures, and information exchange. Manage staff relations including performance management, staff satisfaction and conflict management. Perform and oversee scheduling, recruitment and payroll. Develop and manage the budget and medical staff account, preparing justification for resource allocation and suggestions for discretionary fund expenditures, including overtime, revenue and expense reports for medical staff, resource management, and dues and fees collections. Serve as a principal resource for ensuring compliance with internal and external standards, including accrediting and regulatory agencies, and for guiding decision-making/dispute resolution processes

Requirements

Education:

High school diploma/GED with 2 years of experience, or Associate's degree, or Bachelor's degree required. Work Experience:

3 years of experience required. 5 years of experience preferred. 1 year of leadership or management experience preferred.

Please see job URL for description.
Please note that applicants must reside in the state of Mississippi due to employment law issues.

Open Position: MEDICAL STAFF COORDINATOR (2022-7469) Dept.: Medical Staff (8702) Description: The Medical Staff Coordinator for the Medical Staff Office is a professional qualified to function as a liaison between hospital administration and the Medical Staff. The Medical Staff Coordinator acts independently and maintains strict confidentiality of patient, hospital and medical staff information. This individual oversees credentialing and privileging activities and independently coordinates their own work, prioritizing according to the workflow of the office and established or necessary deadlines. As the workload in this office is heavy, assessing priorities is constant in order to meet deadlines. The job requires diverse analytical skills in order to provide medical staff support as well as interpersonal skills necessary to effectively communicate information and interact with others. Attention to detail is critical in performing key functions. Principle contacts or relationships in the position are Medical Staff personnel, medical staff and their office staffs, administration and hospital employees. Qualifications: Required Tier I: High School Diploma or equivalent (GED), two (2) years of Administrative support experience in a hospital in a business support role such as quality, risk management, medical records and knowledge of basic medical terminology Required Tier II: High School Diploma or equivalent (GED), five (5) years’ experience in Medical Staff, Medical Staff credentialing experience, agenda and minute taking experience, knowledge of basic medical terminology and Microsoft Office computer skills Required Tier III: High School Diploma or equivalent (GED), five (5) years’ experience in Medical Staff Services to include credentialing and meeting, CPMSM or CPCS National Association of Medical Staff Certification and knowledge of basic medical terminology Preferred Tier I: Previous hospital Medical Staff Office experience, Medical Staff credentialing experience, agenda and minute taking experience, knowledge of MDStaff software and CPMSM or CPCS National Association of Medical Staff Certification Preferred Tier II: Bachelor’s Degree, knowledge of MDStaff software, experience using EHR – Meditech and CPMSM or CPCS National Association of Medical Staff Certification Preferred Tier III: Bachelor’s Degree, knowledge of MDStaff software and experience using EHR - Meditech Shift: Full-Time, 1st – Day Shift (possibly evenings) 9/80 work schedule

Overview

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business. We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care. We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients. We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.

Responsibilities

I. Position Requirements:

A. Works in concert with the Team Lead, Facility CEO, Facility credentialing contact to implement and direct the SCA Facility medical staff services and credentialing plan

B. Working knowledge of medical staff services and credentialing processes, procedures and systems

C. Working knowledge of internal and external credentialing resources and organizations such as accreditation and regulatory bodies, and medical staff services and credentialing organizations

D. Knowledge of Facility Medical Staff Bylaws and Governing Body Bylaws, Facility Medical Staff Rules and Regulations, and Facility credentialing policies

E. Maintain communication and direct networking via Internet, company Intranet, web-based and on-site conferences, email, phone with medical staff services and credentialing resources.

F. Possess working knowledge and skills related to preparation, completion, and presentation of reports, related to Facility medical staff services and credentialing plan.

G. Possess effective problem-solving and decision-making skills

H. Possess effective communication and presentation skills for leading and directing committee and program activities

I. Possess excellent organization and time management skills to complete job responsibilities and duties as directed.

J. Ability to work in a demanding situation, changing focus of work due to changing priorities

K. Regularly access internal and external medical staff services and credentialing resources to maintain professional knowledge

L. CPCS (Certified Provider Credentialing Specialist) certification from the National Association of Medical Staff Services preferred

II. Duties and Responsibilities:

A. Direct and manage Facility medical staff services and credentialing plan

B. Directly support Facility management and medical staff regarding medical staff services, credentialing of physicians and allied health practitioners, and performance management of physicians.

C. Knowledge of Joint Commission and AAAHC accreditation standards, state and federal regulatory requirements, National Practitioner Data Bank (NPDB) querying and reporting requirements, and CMS Conditions of Coverage as it relates to credentialing and privileging

D. Working knowledge of current company Medical Staff Bylaws

E. Working knowledge of credentialing/privileging process for medical staff and allied health staff

F. Effectively applies communication process for medical staff committees

Maintains current credentialing and privileging knowledge through:

1. National medical staff services resources networking

2. Membership with national and regional agencies related to Medical Staff affairs, i.e. National Association of Medical Staff Services (NAMSS)

3. Continuing education opportunities

Participates in organization communication and networking related to medical staff services and credentialing through the following:

1. e-mails, phone calls

2. conference calls

I. Assists in establishing and maintaining continuity in the implementation of standards relating to privileging, physician quality and governance functions

Coordinates and supports Facility leadership through the following:

1. Serves as regular resource for medical staff standards, credentialing, and privileging guidelines, required documentation protocols, medical staff file management support, policies and procedures

Manages and maintains organized documentation and recordkeeping process for all medical staff services:

a. Oversees the work of the Expirables Teammates assigned to each facility

b. Maintains current electronic forms, policies and procedures to be in compliance with accrediting and regulatory bodies

II. Duties and Responsibilities (continued):

c. Assists with facility-specific compliance requirements related to medical staff and AHP credentialing:

d. Maintains current documentation of compliance with regulatory agencies, accrediting bodies, and governing bodies as it relates to medical staff services and credentialing

e. Participates with Facility related preparations for accreditation survey readiness related to medical staff standards, credentialing, and privileging guidelines

f. Promotes medical staff compliance with regulatory and accreditation agencies by monitoring the operations of the medical staff process and effectively initiating change when needed

g. Maintains a working relationship under advisement of Facility management related to issues of credentialing and privileging, Medical Executive Committee Bylaws and Governing Body Bylaws, and Medical Staff Rules and Regulations

h. Maintains working knowledge and familiarity with state and federal regulatory requirements, NPDB querying and reporting requirements, and CMS Conditions of Participation as it relates to credentialing and privileging

i. Maintains information on state-specific physician and AHP regulations in the ambulatory setting

j. Participates in credentialing meetings and conference calls as assigned and requested

k. Other duties as assigned by CRS Credentialing Manager

Qualifications

Education, vocational training, and experience: High school diploma or equivalent required;

professional with training/experience in medical staff services and credentialing for the ambulatory surgery setting.

Under the general supervision of the medical staff manager, the Credentials Coordinator is responsible for performing all duties related to the credentialing and privileging processes for medical staff and advanced practitioners.

Under the general supervision of the Credentials Verification Office Director, the Administrative Assistant coordinates and maintains all administrative functions necessary to ensure that the Department runs efficiently and effectively and that a superior level of service is provided to those that rely on the Department for information and assistance. Includes answering phones and directing calls, electronic mailbox management, processing invoices, organizes and schedules meetings, ordering/maintaining office supplies, assist Database Manager with new staff set-up/orientation, report preparation, and miscellaneous credentialing tasks.

Email: jodismithconsulting@yahoo.com for consideration

JOB SUMMARY:

In accordance with The Joint Commission, State, Medical Staff, Hospital Standards, and legal requirements, obtains, verifies, and analyzes all information on medical staff applicants for membership and privileges, and for reappointment. Facilitates review by medical staff and hospital leadership. Facilitates review and approval of Ongoing Professional Practice Evaluation for practitioners with privileges. Interfaces with medical staff officers and leaders, hospital leadership and chairs of supported hospital and medical staff committees and departments to ensure that issues requiring action are reviewed in a timely manner and results are documented and disseminated to the appropriate parties for further review/action, information, education, and/or completion. Schedules and supports medical staff committee and department meetings as assigned. Oversees the completion and adequacy of proctoring and privileging and ensures that physician privileges granted are based on adequate documentation of background and training, experience, and current clinical competence.

MINIMUM QUALIFICATIONS:

• High School Diploma or GED
• 3 years of acute care experience
• Demonstrated knowledge of credentialing principles, credentialing requirements/regulations related to an acute care facility
• 2 years of experience in preparation of Medical Staff meeting agendas, minutes and follow-up correspondence
• Cert Provider Credential Spec (CPCS) or Cert Pro Medical Services Management (CPMSM) certification

PREFERRED QUALIFICATIONS:

• Knowledge of Medical Staff Credentialling Software to support appointment, reappointment and recredentialling cycles of the Medical Staff. i.e. MD Staff, ECHO, Meditech

A successful Credentialing and Licensing Specialist will be professional, polite, attentive and accurate. They should always be prepared and responsive, willing to meet each challenge directly. This person must be comfortable with computers, general office tasks, and excel at both verbal and written communication. Most importantly, this person should have a genuine desire to meet the needs of others.

A Credentialing and Licensing Specialist utilizes considerable latitude, judgment and independent decision-making in response to situations and people, assessing the relative importance of issues/people and prioritizes based on those judgments.

This position is responsible for ensuring functions related to medical staff/allied health professional credentialing and payor enrollments are completed in accordance with applicable legal and regulatory standards within established time parameters.

This position is responsible for processing initial application for privileges, bi-annual medical staff section reappointments, query verifications, complete network (payor) enrollment applications, follow up and other department functions as needed.

Promotes and acts as a role model for CARE principles (Courtesy, Positive Attitude, Respect, and Enthusiasm) throughout the hospital.

Position Overview:

Responsible for processing applications for appointment and/or reappointment from providers as well as other processes pertinent to credentialing, such as change of status, and /or category changes, additional privilege requests, Ensures that appointment and reappointments meet regulatory standards. Interprets the Medical Staff Bylaws, Rules and Regulations, general hospital policies and procedures, and other regulations governing the Medical Staff.

Responsibilities:

• Reviews applications and other documents for completeness and initiates verification of all information contained therein as well as ensuring that request for privileges are appropriate based on set criteria.
• Obtains approvals and provides information for the file review and approval process as appropriate
• Maintains and updates the information for the providers in database
• Supports other competency management functions such as proctoring, performance evaluations, etc. in accordance with bylaws, rules and regulations and policies and procedures.
• Effectively communicates issues and ongoing status of assigned work to Director/Manager

Qualifications:

• Five (5) years of Credentialing experience in an acute care setting.
• Certification in Certified Provider Credentialing Specialist (CPCS) Services Management (CPMSM) is preferred, but must be certified within two years of hire date.
• Knowledgeable concerning the federal and state regulations and standards related to the Medical Staff Functions.
• MD Staff experience highly preferred
• Basic medical terminology preferred
• Knowledge of computer applications and word processing (Microsoft Word, Excel, Power point, etc)
• Organizational skills and ability to communicate effectively both orally and in writing
• Ability to interact with all levels of management and able to set priorities and management multiple demands effectively
• Ability to function well within a team and independently
• Ability to efficiently organize, prioritize, and maintain workload via electronic database and use available resources.

Description:

This position is responsible for assisting with the daily operations of the Office of Integrated Credentialing (OIC), University Clinical Services division, a function which provides primary source verification information to University Clinical Services client Medical Staff practitioners including initial applications and reappointments. University Clinical Services is a brand new peer review organization for the University and the OIC will provide the credentialing function as a service. Ensures excellent service in all areas. Provides guidance and motivation to staff to identify activities that can be streamlined and automated. Assists in development and composing of effective credentialing policies, procedures and processes and implements applicable policies and processes within OIC. Ensures compliance with NCQA standards, background checks, privileges/scopes of practice, and peer references (with some knowledge of TJC, DNV, AAAHC, Title 22, CMS, OIG and NPDB), as applicable. Ensures processes are timely and accurate. Assists with system-wide data dictionary, user training within OIC and other administrative offices as appropriate, for sharing of appropriate database information with appropriate USC departments and systems. Responsible for maintaining productivity standards and ensuring adequate staffing through seasonal credentialing demands, as needed. Coordinates and manages audits under the direction of the Director, if needed.

Minimum Education:

• Bachelors of Arts or Science in a related field is required.

Minimum Experience/Knowledge:

• 3-5 years’ experience with credentialing (required) including at least 2 years in a managerial/supervisory role (preferred) in a medical staff or credentialing office. Thorough knowledge of NCQA standards with some understanding of TJC, DNV, AAAHC, Title 22, and CMS standards.

Required License/Certification:

• Certified “Certified Professional Medical Services Management” (CPMSM) by the National Association Medical Staff Services (NAMSS) or NAMSS “Certified Provider Credentialing Specialist” (CPCS) required. (*If not certified at time of hire, must reach certification within 2 years of hire).
• Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date. (Required within LA City only)

Job Summary: The CVO Credentialing Specialist shall be accountable for performing all the duties related to the sending, receiving, processing, and primary source verifying applications for initial and reappointment and their related clinical privileges. Exemplifies a culture of excellence, effective communication and collaboration, and customer service with CVO leadership and staff, internal and external customers, providers, and clinical and administrative leaders within BILH. Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential. Possesses and/or develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to find common ground. Works to develop an overall singular culture of excellence and efficiency system wide.

Essential Responsibilities:

1. Application management and verification activities, preliminary analysis of application and verification information, and analyzing verification information, to include identifying red flag and/or adverse information and notifying CVO leadership in accordance with CVO policies.
2. Monitoring of expiring information such as, but not limited to, federal and state DEA, state professional license(s), professional liability insurance, and specialty board certification status.
3. Maintain and update credentials file(s) (paper and/or electronic as applicable), timely, accurate, and complete database entries, and maintenance of electronic files, as required.
4. Appropriately and timely communicate with assigned medical staff offices.
5. Timely and accurately prepare credential files for audit and submission to assigned hospitals.
6. Compliance with standard turn-a-round times.
7. Maintain a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws.
8. Assist with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes and assists in the development or revision of credentialing related forms.
9. Participation in special project teams as assigned.

Required Qualifications:

1. High School diploma or GED required.
2. Certified Professional in Medical Staff Management (CPMSM) OR Certified Provider Credentialing Specialist (CPCS) preferred OR Achievement of certification (CPMSM/CPCS) within 24 months of becoming eligible.
3. 1-3 years related work experience required in CVO or Medical Staff Services in an acute healthcare setting.
4. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

1. Knowledge of credentialing software and associated applications.
2. Experience with credentialing and privileging.

Competencies:

1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Job Summary: The CVO Database Support Specialist shall be accountable for day-to-day maintenance, support, training, and optimization of the CVO credentialing database. Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential. Exemplifies a culture of excellence, effective communication and collaboration, and customer service with CVO leadership and staff, internal and external customers, providers, and clinical and administrative leaders within BILH. Possesses and/or develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to find common ground. Works to develop an overall singular culture of excellence and efficiency system wide.

Essential Responsibilities:

1. Maintain and support the credentialing database used by the CVO as well as local hospital medical staff offices
2. Act as a functional and technical resource and system expert
3. Act as a liaison between the system vendor and BILH IT, CVO, and Medical Staff Offices
4. Assures the security, integrity, and confidentiality of the data housed within the credentialing database in accordance with system and/or hospital policies
5. Validates data and maintains data dictionaries for all systems and supports all users by providing education, ongoing assistance, reference and troubleshooting
6. Assists in creating and maintaining productivity graphs, reports, and information (as requested); in the development of data entry and credentialing software operational policies and procedures; and in the development or revision of credentialing related forms.
7. Assists with the integration and optimization of the credentialing software system and with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes
8. Serves as a back-up to team leads and credentialing specialists
9. Leads and/or participates in special project teams as assigned
10. Continually strives to achieve individual, team and departmental goals

Required Qualifications:

1. Associate's degree required.
2. 1-3 years related work experience required in working with a credentialing database in a Medical Staff Office or CVO preferred or utilizing and maintaining databases, including experience with medical terminology.
3. Experience with database technology, excellent interpersonal and communication skills, ability to work under minimal supervision and to adapt quickly to changes within the environment.
4. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Competencies:

1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
8. Customer Service: Ability to demonstrate a positive attitude and respond to requests in a timely and respectful manner.

Job Summary: The CVO Supervisor Credentialing Specialist provides leadership, accountability and direction to credentialing specialists for assigned hospitals. Creates a culture of engaged colleagues through promotion of BILH guiding principles and the development, mentorship and creation of a positive service oriented work culture. Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential. Exemplifies a culture of excellence and customer service in all processes with internal and external customers including current and future members of the medical staff and other LIPs as well as clinical and administrative leaders within BILH. Possesses and/or develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to find common ground. Works to develop an overall singular culture of excellence and efficiency system wide.

Essential Responsibilities:

1. Oversee and assist with application management and verification activities, preliminary analysis of application and verification information, and analyzing verification information, to include identifying red flag and/or adverse information and notifying CVO leadership in accordance with CVO policies.
2. Oversee the monitoring of expiring information such, as but not limited to, federal and state DEA, state professional license(s), professional liability insurance, and specialty board certification status.
3. Maintain and update credentials file(s) (paper and/or electronic as applicable), management of database entries for accuracy and completeness, and maintenance of electronic files as required.
4. Timely and accurately prepare credential files for audit and submission to assigned hospitals and appropriately and timely communicate with assigned medical staff offices.
5. Take a proactive role in monitoring and assisting in improving staff productivity in accordance with standard turn-a-round times, assist in new staff training (as assigned) and assist in the annual evaluation process.
6. Maintain a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws.
7. Assist with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes and in the development or revision of credentialing related forms.
8. Participate in special project teams as assigned.
9. Enforce internal procedures and controls and problem resolution.
10. Continually strive to achieve individual, team, and departmental goals.
11. Has the authority to direct and support employees daily work activities. Has authority to undertake or recommend the following employment actions: hiring, termination, corrective action and performance reviews. Direct Reports: 4-6 Indirect Reports: None

Required Qualifications:

1. High School diploma or GED required.
2. Certified Professional in Medical Staff Management (CPMSM) OR Certified Provider Credentialing Specialist (CPCS) preferred OR Achievement of certification (CPMSM/CPCS) within 24 months of becoming eligible.
3. 3-5 years related work experience required in CVO or Medical Staff Services in an acute healthcare setting and 1-3 years supervisory/management experience required
4. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Preferred Qualifications:

1. Knowledge of credentialing software and associated applications
2. Experience in credentialing and privileging

Competencies:

1. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
3. Independence of Action: Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Manager or Director provides broad guidance and overall direction.
4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.