Credentialing Specialist

Credentialing Specialist, Medical Staff Services, Full Time, Days

Department: Medical Staff Services

Address: 1400 NW N River Drive, Miami, Fl, 33125

Shift details: Full Time, Days

Summary

The Credentialing Specialist is responsible for assuring the integrity of the Corporate Credentialing Department by maintaining a state of readiness for licensing and accrediting agencies, and participating in the daily operations of the Corporate Credentialing Department, to assure effective/efficient systems to support the credentialing process and the organization.

Responsibilities

• Maintains knowledge of regulatory changing requirements and possess the ability to facilitate change in operational systems to be in compliance with regulations as promulgated by JCAHO, NCQA, HIPAA, CMS, AAAHC, Florida State Statues and other regulatory bodies as deemed necessary.
• Provides education to internal and external individuals, departments and agencies when required, as well as direction and support for the functional team of any of the before mentioned agencies.
• Analyzes and participates in recommendations for changes in the Corporate Credentialing policies and procedures on an ongoing basis to conform with internal and external changes as they relate to credentialing.
• Adheres to Corporate Credentialing Policies and Procedures, Bylaws, Rules and Regulations, JCAHO standards & elements of performance, NCQA standards, State and Federal requirements, as well other regulatory agencies to assure readiness for accreditation surveys and other regulatory agency requirements/audits.
• Communicates noncompliance to the Director of Corporate Credentialing. Works closely with Legal, Risk Management, Quality and other areas to ensure compliance within Corporate Credentialing.
• Maintains and assures a collaborative working relationship with Quality Management, Risk Management, Physician Services, Graduate Medical Education and the Chief of each clinical Department to integrate Privileging, Malpractice, Quality, and aggregate data as set by the Chiefs and Committees into the credentialing system.
• Facilitates the entry, storage, and reporting of data elements into the credentialing system such as appropriately entering demographic and expiable updated data for all providers.
• Manages the application and reappointment processes to include research and analytical responsibility for all credentials documentation to ensure that the programs objectives are accomplished per the Bylaws, Rules and Regulations, to include coordination of investigative proceedings.
• Advises the Corporate Credentialing Director, Chiefs of Service, and Committees of issues with providers credentials files, application process and Bylaws issues.
• Maintains responsibility for establishing and maintaining a system to provide quality credentialing services to Medical Staff Members/applicants, being aware of restrictions and prohibitions regarding the nature of material being disclosed, and serves as liaison with others in JHS in their work with Medical Staff Members/applicants regarding privileges and membership.
• Assists with the preparation of Medical Staff and agendas, minutes and reports to the Sub-Credentials Committee(s), Credentials Committee, Medical Executive Committee, Joint Conference and the Board, as required.
• Strictly adheres to departmental operations to ensure that smooth operations, excellent customer service, and legal objectives are met.
• Promotes and maintains team work within the work environment and practices good negotiation skills for resolving conflicts.
• Performs all other related job duties as assigned.

Experience

Generally requires 1 to 3 years of related experience.

Education

High school diploma is required. Bachelor's degree in related field is preferred.

Skill

• Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
• Ability to communicate effectively in both oral and written form.
• Ability to handle difficult and stressful situations with critical thinking and professional composure.
• Ability to understand and follow instructions. Ability to exercise sound and independent judgment.
• Knowledge and skill in use of job appropriate technology and software applications.

Credentials

Valid license or certification is required as needed, based on the job or specialty.

Unit Specific Credential