Credentialing Specialist

Job Summary

The Credentialing Specialist completes the medical staff credentialing process for all medical staff and affiliated professionals. Assures compliance with Joint Commission regulations regarding credentialing for both initial and reappointment applications as well as privileging. Failure to comply with The Joint Commission regulations can result in the hospital losing accreditation as well as having liability exposure for practice of unlicensed physicians or legal action due to credentialing failures. Provides dayto-day management of the Medical Staff Office. Provides administrative assistance to the Vice President/Medical Affairs. Provides staff assistance for Medical Staff Officers and physicians/affiliates as related to credentialing, peer review issues and other matters as requested. Provides assistance with physician recruitment.

Responsibilities

Initial Credentialing of Medical Staff and Advance Practice Provider Staff
Processes/Performs Medical Staff and Advanced Practice Professional Staff appointment and reappointment applications as directed. Performs primary source verification of all required credentials data elements and direct inquiries to all required data banks, profiling providers, licensing/regulatory agencies, etc. Investigates discrepancies and misstatements with applicant and other primary sources as necessary. Determines when investigation and credentials process is complete by comparing and contrasting file to requirements and verifying that all documentation meets standards. Collects and processes credentialing application fees from physician/ affiliates.

Ongoing Maintence and Recredentialing
Manages the monthly re-credentialing process for all network facilities including communication, collection of required materials, and preparation for System Credentials Committee presentation. Maintains/Assists ongoing monitoring of current licenses, malpractice coverage, Drug Enforcement Administration licenses, etc. Organizes and maintain Medical Staff and Advanced Practice Professional Staff credential files as well as other medical staff office documents. Identifies and flag time-sensitive items for reverification. Maintains physician attestation sheets for annual reporting. Maintains the credentials filing system so that staff can easily retrieve files and information.

Maintian Credentialing Systems
Demonstrates knowledge of Credentialing Software System. Maintains accurate, up-to-date practitioner database in the Mon Health credentialing system. Records all credentials information immediately upon receipt. Monitors and track application status and credentials process. Identifies opportunities for improved efficiencies and automation. Always maintain security and confidentiality of files.

Medical Staff Services
Processes verification requests from eternal sources for professional staff affiliation and malpractice insurance. Attends, take minutes, prepare meeting packets, along with sending out meeting notices for committee meetings, as assigned. Gathers statistical data and produce reports as directed. Manages major projects such as large mailings to the Medical Staff and Advanced Practice Professional Staff. Maintains provider call schedules as required. Tracks physician attendance. Prepares and maintains provider rosters. Prepares check requisitions for provider reimbursements per employment agreement, as assigned. Collects activity log and assure data authenticity. Maintains files so that they are up to date.

Medical Staff Governance
Demonstrates knowledge of Medical Staff Bylaws, Policies, and Rules and Regulations. Maintains current knowledge of Joint Commission standards or other regulatory procedures and disseminate information as required. Assists in forming/implementing credentialing policies, procedures, and regulations. Performs all essential functions in compliance with all accreditation standards (JCAHO, NCQA, DME), federal and state laws and regulations and medical staff bylaws and policies/procedures.

Communication
Ensures hospital is aware of all privileges and changes in Medical Staff status or privileging levels. Prepares provider privileged sheets and distribute e-privileges to nursing units for inclusion in the provider privileged books. Generates indexed document sets for Medical Staff Committees, as assigned. Accountable for answering calls and retuning messages in an efficient manner. While, demonstrating exceptional conversation capabilities, telephone etiquette, and useful mindset.Communicates regularly to appraise of application status and/or any missing items. Provides first contact and customer service to professional applicants and credentialing staff.

Office Administration
Coordinates flow of routine office correspondence. Review, copy, and circulate information to appropriate individuals as necessary. Demonstrates good customer service. Always presents professional image. Acts as an internal resource to other staff in relaying information. Continually proofreads work so no revisions are needed due to clerical mistakes. Attends mandatory in-service sessions, staff meetings, and actively participates in self education. Completes all required competency assessments on time. Orders office supplies and other supplies, as needed. Maintains required job knowledge (e.g. licensure and credentials). Maintains security and confidentiality of files. Other duties as assigned.

Knowledge, Skills & Abilities

Light Work: Frequent lifting and/or carrying of objects weighing up to 10 lbs. with a maximum lifting of 25 lbs.

Three years credentialing experience is preferred.Required Skills:• Must possess excellent verbal and written communication skills. • Ability to understand written and verbal instruction. • Advanced office management and clerical skills• Demonstrated proficiency in the utilization of various computer applications • Excellent organizational skills. • Ability to take minutes involving medical terminology. • Effective interpersonal communication skills • Ability to project a professional, positive hospital image, and to maintain a cooperative work relationship with all medical staff and hospital personnel.

Education

Credentials

• Cert Prov Cred Spec (Required)

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Mon Medical Center Main Campus

Location of Job: WV:Morgantown:Mon Medical Center

Talent Acquisition Specialist: Guy S. Stewart guy.stewart@vandaliahealth.org