Coordinator Credentialing DT

• DEPARTMENT: 18400 - Medical Staff
• LOCATION: 350 7th Street North, Naples, FL, 34102
• WORK TYPE: Full Time
• WORK SCHEDULE: 8 Hour Day
  
  

About Nch

NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700 physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.

Job Summary

The Coordinator Credentialing maintains the credentialing and re-credentialing process within the Medical Staff Office. This position facilitates all aspects of credentialing including appointment, reappointment, PPE, monitoring and privileging for medical staff and allied health practitioners. Ensures compliance with the accrediting and regulatory agencies (TJC, AHCA, NCQA, CMS, AAAHC, URAC,) and organizational governing documents regarding credentialing, while developing and maintaining a working knowledge of the statutes and laws. Maintains accuracy of data in credentialing and privileging database system and ensures timeliness of credentialing/re-credentialing verification process. Duties include the gathering, verification and evaluation of confidential healthcare practitioner credential under the direction of the supervisor and director. The Coordinator Credentialing serves as a valuable resource to Administration and Physician Services. Customer focused team player.

Essential Duties And Responsibilities

– Other duties may be assigned.

• Timely processes all credentialing/privileging functions for licensed independent practitioners, in an efficient manner, for recommendations to the appropriate committees (credentialing committee, medical executive committee, and board approval) in accordance with all governing documents, policies and procedures, and all regulatory bodies. Communicates with all applicants and coordinates with applicable managers and directors to ensure appropriate follow up and follow through. Finalizes all board letters and mails within two (2) days of board action and maintains a copy for the credentials file prior to filing. Assists with the completion of the monthly board memo to send to internal staff and others as requested of all board approved actions within two (2) days of the board meeting.
• Collects and cognitively analyzes all information received, appropriately evaluating the quality of the documentation received, pursuing additional information, if necessary, for effective and comprehensive peer review evaluation. Immediately reports to management all information which is averse to the application (i.e. credentialing issues, adverse letters, gaps on application, peer review recommendations, disciplinary actions, etc).
• Maintains accurate credential files on all medical staff and allied health professional members including current licensure, DEA, insurance, disciplinary proceedings and all correspondence relevant to each physician in order to maintain compliance with hospital, state, and other regulatory agencies. Ensures that all expiries are reviewed, obtained and managed on a monthly basis and updated prior to expiration, in accordance with the credentialing policy.
• Coordinates orientation and EMR training for new appointments to the medical staff and allied health professional staff.
• Tracks proctoring activities that support the professional practice evaluation process, including updating the credentialing database for tracking of information.
• Tracks the informal and formal credentialing peer review and recommendation process, working closely with the appropriate section chiefs, department chairs, per established medical staff governing documents. Ensures that all quality review information is obtained and reviewed ongoing and prior to the reappointment process for assigned files; collects and reviews relevant statistical data from leadership of pertinent departments.
• Processes temporary privileges in accordance with the governing documents.
• Prepares and coordinates meetings, (including early morning and evenings); attends and prepares meeting packets and minutes as assigned, including follow up and preparation for reporting through the
  
  

committee structure of the medical staff. Distributes appropriate correspondence utilizing standardized communication tools developed for the department and assures appropriate and timely follow up.

• Prepares confidential reports for medical staff departments and committees.
• Maintains medical staff database systems, identifying medical staff and allied health professional members, their current membership status, appointment data, clinical privileges, and certifications where applicable. Effective and timely entry of changes in the database and disseminates information as necessary.
• Responsible for updating and distributing emergency room on call schedules in accordance with NCH medical staff governing documents, hospital policy, and EMTALA requirements.
• Receives and addresses all medical staff inquires in person, writing, or via phone. Effectively interacts and communicates with hospital employees, medical staff members, patients, and visitors. Participates cooperatively in cross training-coverage initiatives in the department.
  
  

Education, Experience And Qualifications

• Minimum
• of bachelor’s degree with 1-year experience in a clerical office setting OR 7 years of relevant administrative experience required; Healthcare experience preferred.
• Certified as a Certified Professional Credentialing Specialist (CPCS) by the National Association Medical Staff Services (NAMSS) preferred OR obtained or registered for certification exam within 18 months of hire.
• Certified Professional Medical Services Management (CPMSM) preferred.
• Educational competencies must be met through the National Association Medical Staff Services Professionals (CPMSM or CPCS) with continuous certification.
• Independent judgment is essential in resolving varied problems in compliance with established policies, rules and regulations, bylaws, NCQA and TJC standards.
• Experience leading projects and working independently.
• Ability to prioritize multiple competing tasks and complete to deadlines.
• Excellent organizational skills.
• Excellent attention to detail.
• Able to maintain a high level of confidentiality and be diplomatic in approach.
• Flexible approach, adapting in a fast-paced environment.
• Knowledge of medical terminology.
• Customer focused team player.
• Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows