Credentialing Specialist

Description

Position at Western CT Health Network Inc

Summary :

Responsible for ensuring the timely and efficient credentialing, including initial appointment, reappointment and privileging of all new and standing medical staff members in order to be in compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as the Medical Staff Bylaws, Rules and Regulations, policies and procedures and delegated contracts.

Responsibilities :

1. Prepares, disseminates, collects, reviews and processes applications for appointment and reappointment, and accompanying documents, ensuring applicant eligibility.

2. Conducts thorough background investigation, research and primary source verification of all components of the application file, including retrieval of National Practitioner Database Reports in accordance with the Health Care Quality Act.

3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up and closure.

4. Prepares and completes credential files for review by the appropriate department chair and presentation at relevant Medical Staff Committees, ensuring file completion within time periods specified.

5. Reviews and processes request for change in privileges, ensuring compliance with the Medical Staff Bylaws, Credentials Policy, and criteria outlined in clinical privilege descriptions.

6. Reviews and processes requests for change in staff status, ensuring compliance with the Medical Staff Bylaws and Credentials Policy

7. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issue as they arise.

8. Assists with credentialing audits by internal and external surveyors.

9. Utilizes the credentialing database, optimizing efficiency, and performs data entry, query, report and document generation.

10. Adheres to the credentialing and privileging process for assigned medical staff members, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as the Medical Staff Bylaws, Rules and Regulations, policies and procedures and delegated contracts.

11. Creates, updates, and disseminates to relevant individuals within the organization, detailed reports on credentialing activities.

12. Collects appointment and reappointment application fees, annual medical staff dues and reappointment fines.

13. Performs miscellaneous job-related duties as assigned.

14. Fulfills all compliance responsibilities related to the position.

15. Performs other duties as assigned.

Education : HS GRAD / EQUIVALENT

Other Information :

Required : Proficiency in the use of credentialing databases and MS Word, Excel and Outlook. Ability to : communicate effectively, both orally and in writing; work effectively in a team environment; plan, prioritize and work multiple actives and tasks effectively, to produce work in high quantity and quality; to analyze, interpret and draw inferences from research findings and to prepare reports; to use independent judgment to manage and impart confidential information. Must have knowledge of related accreditation and certification requirements, to have knowledge of medical credentialing and privileging procedures and standards, working knowledge of clinical and / or hospital operations and procedures, database entry and management skills including querying, reporting and document generation.

Minimum Experience : three years

Desired : Associate's degree desired.

Working Conditions :

Manual : significant manual skills / motor coord & finger dexterity

Occupational : Little or no potential for occupational risk

Physical Effort : Sedentary / light effort. May exert up to 10 lbs. force

Physical Environment : Generally pleasant working conditions

Credentials : CPCS

Company : Western CT Health Network Inc

Org Unit : 305

Department : MCA - Credentialing

Exempt : No

Salary Range : $20.86 - $38.73 Hourly