What are the responsibilities and job description for the 90000-5, HIM Credentialing Specialist position at CAMBRIDGE MEMORIAL HOSPITAL, INC?
Essential Functions:
- Attention to Detail — Job requires being careful about detail and thorough in completing work tasks.
o Assists with the processing of credentialing applications and appointment/reappointment processes. Assures all applications are processed completely and in a timely manner.
o Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with medical staff Bylaws, medical staff Rules and Regulations, and accrediting organization standards.
o Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners. Conveys any problems or concerns to the Health Information Management Director for further review.
o Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
o Prepares, issues, tracks, and follows-up on appropriate verifications for efficient processing of individual applications.
o Prepares forms, reports and provider scorecards as required.
o Knowledge of medical staff bylaws, medical staff rules and regulations, as well as accrediting organization standards, Center for Medicare and Medicaid Services (CMS) regulations, state regulations and other regulatory agencies as they pertain to medical staff and allied health professionals.
- Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
o Works with a Credentials Verification Organization (CVO) to collect, validate and assess completeness of all information and qualifications relative to credentialing standards of Tri Valley Health System.
o Communicates clearly with providers, their liaisons, the Medical Staff, leadership, and administration as needed regarding credentialing and privileging issues as they arise.
o Prepares and provides information to internal and external customers as appropriate.
o Communicates regularly with the Health Information Management Director regarding any problems, issues or concerns in his/her sections.
o Deals with a wide variety of personalities in a professional and tactful manner.
o Collaborates and coordinates with medical staff leaders and administrative representatives.
o Assists in answering the telephones and taking accurate messages.
o Maintains a good working relationship within the department and other departments.
- Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations.
o Regular and Reliable Attendance.
o Coordinates and completes all medical appointment and reappointment processes in a timely manner to ensure compliance.
- Integrity— Job requires being honest and ethical
o Protects the confidentiality of all records, as well as access to computer files and access codes.
o Supports and maintains a culture of safety and quality.
- Initiative — Job requires a willingness to take on responsibilities and challenges.
o Ability to prioritize activities day-to-day, guiding oneself with little supervision and depending on oneself to get things done.
o Stays current in field through continuing education, professional societies and journals.
o Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
o Performs miscellaneous job-related duties as assigned.
- Compliance
o Promotes and adheres to the provisions of the compliance program.
o Communicates the mission, ethics and goals of the facility.
o Complies with all organizational policies regarding ethical business practices.
o Promotes and adheres to the TVHS core values and Standards of Behavior.