Credentialing Specialist II-Medical Staff

SUMMARY:

Performs and monitors all credentialing functions, including complex credentialing issues and brings forward issues to the Medical Staff Credentialing Lead and/or Director. Interfaces with senior medical staff leaders and administration and presents information when necessary. Utilizes knowledge of bylaws, rules, and regulations, expertise, sound judgment to mentor and support Medical Staff Credentialing Specialists I, other peers, and leadership. Acts as a liaison between Administration and members of the Medical Staff.

ESSENTIAL FUNCTIONS:

·         Apply knowledge, expertise, sound judgment and consult other references and resources as necessary to generate and evaluate solutions and recommendations.
 

·         Applies knowledge of bylaws, rules, and regulations to effectively serve as a Medical Staff information resource, to ensure timely flow of work, and sound judgment to mentor and support Medical Staff Credentialing Specialists I, other peers, and leadership. 
 

• Ensures compliance with all applicable Accreditation agencies. Supports oversite and participate in internal, external, compliance surveys, reviews and audits as required.

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

 

·         Coordinates, monitors and maintains the credentialing and recredentialing process.

·         Reviews applications and other data for accuracy and completeness, including processing application fees and other receipts received during the verification process.

 

·         Performs primary source verification of initial and reappointments applications by preparing requests for information letters, tracking responses and follow-up for needed information.

·         Obtains, reviews, and collects accurate data licensure, insurance, and other certificates at time of reappointment. or as they expire) for each applicant in the database and responds to verification requests.

·         Ensures the accuracy of documentation to support the request for privileges by maintaining good working relationships with clinical departments, Medical Staff leadership and professional agencies.

·         Answers phones, makes copies, prepares mailings, and maintains files.

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

·         Supports Medical Staff meetings; records meeting minutes and maintains an accurate record of decisions as required; including board letters prepared and distributed as required.

·         Maintains register of applications and expired certificates/licenses and assists with all mid-cycle updates.

·         Processes application fees and records deposits as required.

• Adheres to TMCH 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) required.

EXPERIENCE: Two (2) to Four (4) years of medical staff privileging or credentialing experience in required.

LICENSURE OR CERTIFICATION: None required. CPCS or CPMSM preferred.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Intermediate to Advanced Knowledge of healthcare practices and procedures.
• Advanced Skills in maintaining a detailed database, creating reports, and maintaining files.
• Intermediate to Advanced Ability to read, analyze, and interpret general business periodicals, professional journals, technical and software related procedures and manuals, governmental regulations.
• Display promotes and inspires trust and confidence among team members and stakeholders through reliability, authenticity, and accountability.
• Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward and across the organization by actively listening and encouraging open expressions of ideas and opinions.
• Establishes and maintains productive and cooperative relationships with team members, peers, management, and stakeholders both internal and external to the organization.
• Intermediate to Advanced ability to effectively present information and respond to inquiries regarding any issue related to the Credentialing and Privileging process.
• Intermediate to Advanced skills to define problems, collect data, establish facts, and draw valid conclusions.