Credentialing Specialist II - Medical Staff Services

SUMMARY:
Performs and monitors all credentialing functions, including complex credentialing issues and brings forward issues to the Director.  Interfaces with senior medical staff leaders and administration and presents information when necessary.  Maintains the provider database, including developing reports, data entry, provider information and updates, creation of custom fields and troubleshooting problems.  Serves as the organization’s liaison with the software vendor and Information Services.  Administers projects for medical staff committees and/or chairman.  Acts as a liaison between Administration and members of the Professional Staff. 

ESSENTIAL FUNCTIONS:

Maintains, troubleshoots and supports software application for Professional Staff Services.  Serves as a liaison between software vendor and Professional Staff Services.

Applies knowledge of bylaws, rules, and regulations to effectively serve as a Professional Staff Representative, to ensure timely flow of work. 

Oversees Ensures compliance with all applicable regulatory requirements.

Utilizes credentialing software for new and reappointment letters, resignations, leave of absences, changes in staff category, add/delete privileges.

Effectively communicates with peers to ensure information regarding practitioners is current.

Contributes to the credentialing process of all practitioners as needed and appropriate.

Creates and manages Emergency Department call schedules.

Creates and maintains ED Call Reimbursement spread sheet and monitors timely payment

Develops and analyzes reports from the practitioner database for hospital wide requests as approved by the director.

Composes correspondence including board letters as required.

Plans and supports Medical Staff meetings; records meeting minutes and maintains an accurate record of decisions.  

Maintains register of applications and expired certificates/licenses and assists with the delegation to Credentialing Specialist I staff of all mid-cycle updates.

Processes application fees and records deposits as required.

Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  High school diploma or general education degree (GED) with extensive computer background. Preferably, associate’s degree in computer science and/or health field with advanced computer courses.

EXPERIENCE:  Four (4) years of credentialing experience in an acute care setting, preferably involving computer software oversight, or lead responsibilities.

LICENSURE OR CERTIFICATION:  None required.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of healthcare practices and procedures.

• Skill in maintaining a detailed database, creating reports and maintaining files.

• Skill in computer applications and troubleshooting problems.

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical and software related procedures and manuals, governmental regulations.

• Ability to prepare detailed reports, written correspondence and procedure manuals.

• Ability to effectively present information and respond to inquiries or complaints from employees, patients and/or their representatives, providers and the general public.

• Ability to add, subtract, multiply, and divide using whole numbers, common fractions and decimals.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

• Ability to interpret technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.