Medical Staff Credentialing and Provider Enrollment Job Listing at Baton Rouge General in Baton Rouge, LA (Job ID 2013568348)

Description

JOB PURPOSE OR MISSION:  Coordinates Medical Staff meetings, privileging/credentialing activities, and compilation and review of standing orders for assigned physicians/areas of responsibility. Serves as liaison between medical staff, nursing staff, and administration where assigned. Provides administrative and clerical support for the department.  Serves as a resource and lead worker for Medical Staff Services.

ESSENTIAL JOB FUNCTIONS include, but are not limited to:

1. Manages assigned process for Medical Staff meetings.

PERFORMANCE STANDARDS:

• Coordinates all activities associated with meeting management for assigned areas accurately, and within appropriate time lines for notifications and correspondence.
• Ensures processes defined by the medical staff bylaws and department policy and procedure are followed all of the time.

1. Manages assigned privileging and credentialing processes for Medical Staff, Allied Health, and other assigned staff.

PERFORMANCE STANDARDS:

• Maintains a current knowledge base and follows processes as outlined by JCAHO, legal precedents, Medical Staff Bylaws and department policy and procedure for initial appointment and reappointment to the Medical Staff.
• Demonstrates effective execution of the initial appointment and reappointment processes for assigned area accurately.
• Ensures accuracy, currency, and accessibility of:
  • Medical License Malpractice Insurance
  • Reappointment Applications
  • Continuing Medical Education
• Complies with requirements for National Practitioner Data Bank, including queries and submission of information.
• Maintains, consistently uses and continuously improves the credentialing forms, privilege delineation forms, documentation, filing system and letters needed for credentialing.
• Maintains integrity of credentialing database with timely, accurate and thorough information.
• Maintains an organized and readily available list of key physician and Allied Health professionals.

1. Coordinates the compilation, revision and annual review of standing orders for all physicians.

PERFORMANCE STANDARDS:

• Works with new physicians to compile standing orders and works with Marketing to have orders placed in standard format.
• Distributes standing orders to appropriate areas for review, obtains final approval from physician and ensures orders are posted, within established timeframes.
• Revises existing standing orders as needed per physician instructions and follows established procedure.
• Coordinates annual review of existing standing orders, makes changes as necessary, and obtains physician approval.

1. Provides support on special projects and department budgetary requirements as assigned.

PERFORMANCE STANDARDS:

• Maintains current working knowledge of Medical Staff Bylaws and is well versed on content, intent and industry trends.
• Maintains, updates and distributes copies of Medical Staff Bylaws on an ongoing basis.
• Demonstrates application of specialized knowledge when participating in research and revision projects.
• Functions as high-level user on applicable software programs and acts as IT liaison between Medical Staff Services, other internal departments and vendors.

1. Facilitates dissemination of information/communication to all appropriate areas as assigned.

PERFORMANCE STANDARDS:

• Provides distribution of assigned routine reports.
• Coordinates monthly mailings and completes on a timely basis.
• Provides accurate monthly membership roster to key GHS executives.
• Maintains monthly Medical Staff Calendar accurately.

1. Serves as resource for work group.

PERFORMANCE STANDARDS:

• Serves as mentor to new employees.
• Completes orientation checklists with new employees.
• Serves as resource to others in complex situations.
• Assists director with training and evaluation of departmental staff.
• Manages workgroup activity in support of department/hospital/system performance improvement.
• Coordinates the implementation, and revision, when needed, of office policies and procedures.

1. Functions as lead worker for group.

PERFORMANCE STANDARDS:

• Trains new employees and documents training, according to established guidelines.
• Demonstrates teamwork and actively fosters cooperation both within the department and with other departments.
• Presents new and creative ideas to improve the quality of service.
• Acts as a liaison between the Medical Staff, Nursing Staff and Administration within the parameters established by the Director, Medical Staff Services.
• Supervises credentialing process of new applicants and reappointments to the medical staff in compliance with JCAHO and HCFA standards.
• Disseminates policies, procedures, memorandums, and any pertinent documents or information to members of the medical staff.
• Adheres to internal controls established for department.

8. Assist with the day to day task for Provider Enrollment.

            PERFORMANCE STANDARDS

• Enter and maintain provider applications, payers, and updates into the system.
• Enter and maintain all provider information into credentialing database.
• Verify prospective and current providers' license, liability insurance, CDS certificate, and DEA certificate, if applicable.
• Verify providers' education, hospital privileges, board certification, and other criteria as required.
• Verify accurate banking and billing information.
• Perform ongoing research to correct data so that it does not create duplicate providers, locations, payees, and participation statuses.
• Maintain credentialing information by reviewing, entering, and following up on missing information.
• Review National Practitioners Data Bank for adverse charges pending or filed against providers, only for delegated agreements.
• Track contract applications status.
• Ensure all files have a welcome, denial, or term letter as appropriate.
• Meet required turnaround times and accuracy rates.
• Keep up-to-date provider enrollment process and records, and track provider participation levels.
• Participate in credentialing committee as necessary.
• Coordinates activities associated with meeting management for assigned areas accurately, and within appropriate timelines for notifications and correspondence.
• Update the system and the credentialing database to reflect approvals, denials, and/or terminations.
• Provides support on special projects and department budgetary requirements as assigned.
• Facilitates dissemination of information/communication to all appropriate areas as assigned             

9. Performs all other duties as assigned.

2 years of experience as a Provider Enrollment and Medical Staff Coordinator preferred.

EDUCATIONAL REQUIREMENTS

High School Diploma or GED preferred.

SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS

Certified Medical Staff Coordinator preferred.

Working knowledge of medical terminology preferred.

Basic knowledge of computers essential with working knowledge of word processing, spreadsheet, and graphics programs.