Credentialing Specialist (Remote)-(3290377)

Description

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system.

Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities.

Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential.

Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors.

We support each member of our team to own their personal development and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done : Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk;

and how we treat each other : Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

General Summary

Responsible for the administrative duties required in the credentialing verification process. Reviews, enters, and maintains specialized applicant information in a complex database and coordinates the credentialing process for the Medical Staff offices of the respective entities.

Ensures the credentialing process complies with organizational as well as an accrediting agency, Federal, and State regulatory standards.

Works in a team environment within the department and with the Medical Staff offices.

Duties & Responsibilities

Responsible for the following steps of the credentialing process :

• Processing of departmental credentialing requests, in accordance with established procedures and time frames.
• Preparation of reappointment packets for assigned area of responsibility.
• Tracking of reapplications sent, received, and processing time.
• Takes action on non-returned (re)applications and conducts follow-up of incomplete (re)applications in accordance with policies and procedures.
• Reviews (re)applications for clarity, quality, and completeness of data in accordance with policies and procedures.
• Performs timely and accurate scanning, data entry / entry validation of application information received in the database
• Initiation of the verification process within established time frames.
• Conducts follow-up on missing data and / or discrepancies in accordance with established time frames.
• As responses to verification requests are received, compare the responses with the information provided by the applicant to ensure accuracy and completeness.
• Works to ensure the verification process is completed within established time frames to allow entity to time to complete the committee reviews prior to appointment / next reappointment date.

Informs entity contacts and CCO team lead / manager, of the verification status of applicants, including providing updates on any potential problems identified during the verification process in accordance with established procedures and time frames

• Provides timely resolution of any verification problems / discrepancies in order to ensure timely completion of the verification process.
• Keeps applicants (initial and reappointment) informed of the status of credentialing process which includes timely use of all correspondence as well as proper notification to the applicant.
• Serves as a liaison with Medical Staff Offices and other internal / external customers as it relates to practitioner related issues and concerns.

Data management, administrative responsibilities :

• Maintains an electronic record / file for all practitioners within the credentialing database giving attention to operational concerns and the need for others to retrieve the same records.
• Responsible for notifying manager when a policy or procedure is found to be in need of revision due to changes in laws / regulations, inaccurate, or unable to be accomplished as written.
• Maintains integrity of electronic, specialized database, which includes the importing of practitioner information in accordance with departmental policies and procedures.
• Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation.
• Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database.
• Assists with the development and revision of the credentialing and audit workflows within the credentialing database.

Training and development :

• Maintains competency on vendor database via participation in online education learning modules and monthly skills related webinars
• Maintains competency in nationally recognized credentialing-related initiatives through participation with NAMSS and MAMSS, journal articles, and other industry-related news.
• Participates in the orientation of new staff members, as assigned.
• Use / s the Partners HealthCare values to govern decisions, actions, and behaviors. These values guide how we get our work done : Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk;

and how we treat each other : Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration

Other duties as assigned

Qualifications

Qualifications

• High school diploma or equivalent. Associate’s or Bachelor’s Degree in a related field preferred.
• 3-5 years of experience in credentialing services or related field
• CPCS preferred

Skills / Competencies

• Working knowledge of general office practices and software applications and database management. Demonstrated understanding of credentialing policies and procedures and training program requirements as established by the CCO, as well as accreditation and regulatory requirements relating to the medical staff.
• Organizational skills required to handle high data flow and to prioritize tasks in order to meet cyclical 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.
• Possesses ability to manage specialized database, including production of reports covering the area of responsibility.
• 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.
• Communicates effectively and professionally with applicants or colleagues by telephone or in person.
• Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
• Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds an levels within and external to the organization
• Strong problem solving and negotiation skills
• Requires minimal direction from leadership and possesses the ability to learn quickly

Last updated : 2024-05-16