Primary Function

Responsible for the effective function and coordination of the credentialing and re-credentialing process and other assigned tasks. Coordinates with physicians, external agencies, administration, nursing department, risk management / performance improvement department, and medical records department. Reports to the CVO Director.

Nature and Scope (Essential Functions)

Process applications and reapplications in accordance with each AHMC hospitals medical staff bylaws, policies, TJC, and Title 22 requirements.

Complies with each AHMC hospitals policies and procedures and performs the credentialing and re-credentialing process in a timely and accurate manner.

Applications that do not meet the basic AHMC hospital medical staff membership requirements are returned within the established timelines.

Inputs the required information accurately in the Verification Checklist within the MD-Staff database program.

Keeps the CVO Director informed of potential problems relating to pending applications or reapplications, or applicants/reapplicants who may not meet the criteria for membership to any of the AHMC hospital medical staffs.

Process reapplications timely and prior to the expiration of the current appointment.

Obtains pertinent information on malpractice claims, data banks reports, AMA profiles, etc. and relays the information to immediate supervisor and the appropriate AHMC hospital.

Demonstrates thorough knowledge of the credentialing, appointment, reappointment, and profiling process including knowledge of MD-Staff.

Understands various AHMC hospitals and departmental operations, policies and procedures and can apply them to any situation.

Understands basic functions of the various AHMC department/s and can readily identify sources of information in the analysis.

Understands the organizational structure of the AHMC healthcare CVO and various AHMC hospital medical staffs and applies knowledge in relationships with others.

Independently recognizes and performs duties that need to be done without being directly assigned. Establishes priorities; organizes work and time to meet them.

Recognizes and responds to priorities, accepts changes and new ideas. Has insight into problems and the ability to develop workable alternatives.

Understands and abides by all departmental policies and procedures as well as the Codes of Ethics, HIPAA requirements and patient rights.

Complies with federal, state, local laws that govern business practices. Complies with all Department of Health Services requirements for the State of California, and HCFA standards that apply to the position.

Demonstrated knowledge and adheres to JCAHO/DHS/CMS standards specific to the position.

Conducts business in an ethical and trustworthy manner at all times when dealing with patients, visitors, physicians, and fellow employees.

Understands respects and displays sensitivity to culture, age and persons with disabilities. Participates actively and positively affects the outcomes of customer service activities.

Performs other duties as assigned.

Accountability

1. The incumbent is responsible for the timely processing of medical staff applications and reapplications.
2. The incumbent is responsible for directing the development and coordination of specific projects assigned.
3. This position is responsible for promoting an environment of teamwork with all members of the organization.
4. The incumbent is responsible for assuring the assigned projects are completed in a timely and efficient manner.
5. The incumbent is responsible for developing and training staff as necessary in order to execute new programs, and/or initiatives.
6. The incumbent is responsible for coordinating with internal and external resources to ensure the success of the assigned projects.
7. This position is responsible for assuring all stakeholders are well informed and have the tools necessary to execute as needed.
8. The incumbent is accountable for communicating to immediate supervisor of any possible issues, which may arise in order to proactively develop an action plan to minimize or eliminate the issue.
9. The incumbent is responsible for acting in an ethical manner at all times.
10. The incumbent is accountable for maintaining confidentiality.
11. The incumbent is responsible for complying with all company policies and procedures.
12. The incumbent is responsible for complying with all local, state and federal laws.

Qualifications

1. Two (2) years of credentialing experience in a hospital medical staff office.
2. College degree preferred.
3. Knowledge of federal, state and local healthcare regulations.
4. Knowledge of HIPAA and privacy regulations.
5. Possess excellent grammar, composition, and communication skills.
6. Ability to communicate effectively with internal and external resources.
7. Excellent oral and written skills.
8. Ability to work independently.
9. Must possess excellent human relation skills.
10. Must possess excellent critical thinking skills.
11. Possess strong organizational skills with ability to multi-task, and prioritize workload.
12. Ability to interpret, prepare, and present reports to management in both written and oral formats.
13. Ability to make presentations, design and provide training education to staff and management.