CREDENTIALING SPECIALIST

Overview: The Credentialing Specialist I demonstrate excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant and the commitment to Extraordinary Care for Every Generation. This individual is responsible for providing technical expertise for initiation and follow-through of the application process for appointment and reappointment of Medical Staff and Allied Health Professionals requiring a thorough understanding of the credentialing process; maintains accurate and complete data in MSO for Windows software system, and generates queries and reports; maintains organization and confidentiality of Medical Staff documents, maintains knowledge of all Medical Staff functions, including HFAP standards, and state, federal and legal requirements. Responsibilities:

Responsibilities

MEDICAL & ALLIED HEALTH PROFESSIONAL INITIAL CREDENTIALING

Responds to requests for appointments by sending applications and appropriate clinical privileges/service authority forms.

Responsible for accurate primary source verification of credentials, including all licenses, education, hospital and employment affiliations, references, criminal background check, federal sanction, National Practitioner Data Bank, American Medical Association, and ECFMG.

Monitors status of applications by responding to provider and primary sources to obtain information in a timely manner.

Assists section chiefs and department chairs in the application review process. Has knowledge of Medical Staff Bylaws and credentialing policies to direct them appropriately.

Prepares and transmits application packets to Credentials Committee members for their review.

Maintains the highest level of confidentiality with credentialing files.

Reviews negative findings with Medical Staff Services manager.

Assists other hospitals/organizations in their credentialing process by responding to appropriate requests for information.

Assures compliance with HFAP standards, state, and federal requirements.

Contributes to the organization’s financial goals by ensuring timely processing of appointment applications.

MEDICAL & ALLIED HEALTH PROFESSIONAL REAPPOINTMENTS

Responsible for initiating reappointment process for each Medical Staff /Allied Health Professional member every two (2) years as per HFAP standards.

Responsible for accurate primary source verification of credentials, including all licenses, criminal background check, federal sanctions, National Practitioner Data Bank, and American Medical Association.

Monitors status of applications by responding to provider and primary sources to obtain information in a timely manner.

Obtains statistics on volumes and quality of care provided by Medical Staff/Allied Health Professional members.

Prescreens reappointment forms and delineation of privileges prior to presentation to department chair to ensure they have all the necessary information to make recommendations.

Reviews negative findings with Medical Staff Services manager.

Assists section chiefs and department chairs in the application review process. Has knowledge of Medical Staff by laws and credentialing policies to direct them appropriately.

Maintains confidential reappointment files.

Assures compliance with HFAP standards, state, and federal requirements during the reappointment process.

CREDENTIALING LOCUM TENEN PRACTITIONERS

Responsible for initiating the locum tenens credentialing process when notified by the department head.

Works closely with the department head and the staffing agency to ensure timely completion of credentialing process.

Responsible for having knowledge and understanding Medical Staff By laws and Credentialing policies related to the use of Locum Tenens practitioners in the organization.

Responsible for accurate primary source verification of credentials, including all licenses, criminal background check, federal sanctions, National Practitioner Data Bank, and American Medical Association.

Monitors status of applications by responding to provider and primary sources to obtain information in a timely manner.

Prescreens locum tenens credentialing delineation of privileges prior to presentation to VPMA and Chief of Staff. Ensure all information is present for the VPMA and Chief of Staff to make a recommendation.

Reviews negative findings with Medical Staff Services Manager.

Maintains confidential locum tenens files.

Assures compliance with HFAP standards, state, and federal requirements during the credentialing process.

Contributes to the organization financial goals by ensuring timely processing of locum tenens applications.

OTHER DUTIES

Responsible for accuracy of provider demographics that are inputted into the credentialing software.

Responsible for understanding the Medical Staff Chapter HFAP standards and applying them to the credentialing process.

Responsible for staying current on credentialing industry best practices.

Networking with local and state-wide colleagues is expected.

Qualifications:

EDUCATION/EXPERIENCE

Associate's Degree in Health Services Administration or Business required, Bachelor’s prefer red. In lieu of, Associate’s degree, high school diploma with three (3) years of direct credentialing or health plan payor enrollment experience will be accepted .

Knowledge of graduate medical education, physician/hospital office experience or health plan payor enrollment experience required. Medical terminology required. Experience with electronic credentialing software: MD Staff or other credentialing software required. Hospital-based medical staff office experience preferred.

KNOWLEDGE/SKILLS/ABILITIES

Computer and word processing ability including Microsoft Word and Excel, typing, ability to communicate well with others, proficiency in listening, writing, and speaking.

Excellent written communication skills for constructing minutes and correspondence, and excellent verbal skills for communicating individually and in group meetings.

Excellent word processing and computer skills.

Incorporates continuous quality improvement principles into daily activities.

Strong interpersonal, diplomatic, and organizational skills.

Demonstrates ability to maintain information in a confidential manner.

Customer Service focused on all daily activities.

Demonstrates ability to make sound independent decisions within boundaries of polices, and procedures.

WORKING CONDITIONS/PHYSICAL DEMANDS

Frequently stand, walk, sit, talk, and hear.

Prolonged periods of sitting and computer use.

Frequent periods of listening to difficult people.

Requires the physical ability and stamina to perform the essential functions of the position. Ability to lift up to 10 pounds, carry, push, pull, climb, stoop, kneel and squat.