Coordinates and administers day-to-day support of the credentialing and privileging process for West Virginia University Hospitals and West Virginia United Health Systems.

The process includes, but is not limited to, new applications, provisional reviews, and biennial reappointments for members of the Medical Staff, Licensed Independent Practitioners and Advanced Practice Professionals as defined by the Hospital’s Medical Staff Bylaws.

MINIMUM QUALIFICATIONS :

EDUCATION, EXPERIENCE, CERTIFICATION, AND / OR LICENSURE :

1. Bachelor’s degree in business or a health-related field AND one (1) year of experience in an administrative setting.

Associate Degree in business or a health-related field AND three (3) years of experience in an administrative setting.

High School Diploma or equivalent AND five (5) years of experience in an administrative setting.

PREFERRED QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND / OR LICENSURE :

2. Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Service Management (CPMSM) OR obtained within twelve (12) months of hire.

EXPERIENCE :

1. Three (3) years’ experience in a medical staff credentialing role, preferably as a Medical Staff Coordinator or equivalent.

2. Experience in a hospital or medical facility.

CORE DUTIES AND RESPONSIBILITIES : The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Coordinates the timely credentialing, recredentialing and privileging of new and current Physicians, Dentists, Licensed Independent Practitioners and Advanced Practice Professionals following Joint Commission and National Committee for Quality Assurance (NCQA) standards.

2. Maintain working knowledge of Joint Commission, NCQA, State Medical Boards and Centers for Medicare & Medicaid Services (CMS) standards.

3. Monitors and updates the credentialing process, including applications for appointment, reappointment, clinical privilege forms and policies to ensure compliance with Joint Commission, NCQA and CMS standards.

4. Performs Primary Source Verifications of practitioner information in compliance with Joint Commission, NCQA and CMS standards.

5. Enters, maintains and updates practitioner information into the electronic credentialing software in an accurate and timely manner.

6. Maintains a current knowledge of the Medical Staff Bylaws, Rules & Regulations and Credentialing policies.

7. Participates in Joint Commission, Office of Health Facility Licensure & Certification (OHFLAC) and Managed Care Organization (MCO) surveys as it relates to the credentialing and privileging of Physicians, Dentists, Licensed Independent Practitioners and Advanced Practice Professionals.

8. Serves as the WVUH liaison to Managed Care Organizations in regard to performing delegated credentialing functions in accordance with contractual agreements.

9. Work with Information Technology and the electronic credentialing software vendor to maintain a current system through updates and training.

10. Participates in project work identified by the leadership of Medical Staff Affairs.

PHYSICAL REQUIREMENTS : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment

SKILLS & ABILITIES :

1. Ability to function in a demanding and fast-paced environment.

2. Proficient computer skills including, but not limited to thorough knowledge and understanding of office software programs including Windows, Excel, Outlook, or similar applications.

3. Possess excellent organizational and prioritization skills.

4. Possess professional communication skills.

5. Must be detail oriented and possess excellent spelling and grammar skills.

Last updated : 2024-05-22