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JOB SUMMARY

Manages advanced credentialing and privileging processes, ensuring compliance with regulatory standards. Serves as subject matter expert and liaison between medical staff, administration, and regulatory bodies.

ESSENTIAL FUNCTIONS OF THE ROLE

Audits and evaluates processes involved in verifications for medical staff, allied health practitioners, and advanced practice professionals' appointments, reappointments and privileges delineations. Audits applications, review supporting documents including all primary source verification for credentialing and re-credentialing to ensure medical staff and advance practice professional files are current and policies and procedures have been followed to obtain required documentation and verification.

Coordinates the processing of applications through the hospital review process and committee meeting structure and assures all applications are processed completely and in a timely manner.

Responsible for auditing files that are asked to be reviewed during regulatory surveys (TJC, CMS, Etc.) and presenting such files to the surveyor (duties of facility team lead).

Responsible for preparing final Credentials Report for Governing Board (Board) and for preparing change memo notification to general staff after Board meeting (duties of facility team lead).

Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, advance practice professional policies, as well as other policies and procedures pertaining to credentialing, etc.

Works with manager and/or director for assuring that the findings, conclusions and recommendations for actions to appointment or reappointment applications and/or improve the credentialing program are reported through appropriate medical staff committees, or appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.

Responsible for contacting Credentials Committee Members regarding monthly review of credentials files and serve as resource to the reviewers for any questions that may arise. Coordinates the processing of applications through the hospital review process and committee meeting structure.

Attends meetings and assists with the preparation of agendas, research and committee packets (duties of facility team lead).

Works with manager and/or director and makes recommendations for credentialing and privileging forms as needed. Oversees ongoing development and revisions of delineation of privileges utilizing heavy physician input and physician committee approval. (Duties of facility team lead)

Participates in system integration and continuing quality improvement efforts. Assures appropriate implementation of new credentialing software and ongoing development efforts as I related to regulatory agency requirements for credentialing.

Responsible for the primary interface with Credentials Committee Chairmen, and other key medical staff leaders around medical staff issues. Serves as information resource in credentialing to medical staff and advance practice professionals.

Provides administrative and technical support to medical staff department and committee meetings. Works with manager and/or director for follow up action as required including composition of correspondence for chief/chairperson as well as distribution of materials.

Performs other position appropriate duties as required in a competent, professional and courteous manner.

KEY SUCCESS FACTORS

Independently manage credentialing, reappointment, and privileging processes.

Interpret and apply medical staff bylaws, rules, and regulations.

Ensure compliance with TJC, CMS, and state regulations.

Exhibits high degree of responsibility for confidential matters.

Commitment to continuous learning and keeping abreast in the Medical Staff Services industry.

Experience in database management, medical staff and/or credentialing services required.

Prepare and present credentialing files to medical staff committees.

Lead audits and readiness for accreditation surveys.

Train and mentor junior staff.

Collaborate with legal, quality, and risk departments on provider issues.

BENEFITS

Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

- EDUCATION - H.S. Diploma/GED Equivalent

- EXPERIENCE - 3 Years of Experience

- CERTIFICATION/LICENSE/REGISTRATION -
       Cert Medical Staff Coord (CMSC), Cert Provider Credentling Spec (CPCS), Cert Prof Medical Services Mgr (CPMSM): Must obtain one of the following within 24 months of hire:
-- Certified Medical Staff Coord (CMCS) or
-- Certified Provider Credentialing Spec (CPCS) or
-- Certified Prof Medical Services Manager (CPMSM).

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