Description
Job Summary:
Under minimal supervision, initiates the appointment/credentialing and reappointment/ recredentialing process, compiling and processing data in compliance with local, regional, state and federal accreditation requirements. Ensures thorough and timely verification of Licensed Independent Practitioners (LIP) and Allied Health Professional Staff (AHP) credentials and privileges according to local and regional medical staff services policies and procedures for practitioners in both the hospital and/or ambulatory settings. Provide medical staff service support services to professional staff by supporting professional staff committee meetings, initiating the proctoring function, tracking of residents/medical students and acting as a resource for physicians, allied health professionals, medical center leadership and patients. Completes specific time-limited project assignments as delegated by Director of Medical Staff Services or Senior Medical Staff Coordinator. Assist in audit of practitioners credentialing and recredentialing files to ensure all required elements are in place and in accordance with Regions policy, regulatory and accrediting agency requirements, prior to committee review and approval.
Essential Responsibilities:
- Audit practitioners credentialing and recredentialing files to ensure all required elements are in place and in accordance with Regional policy, regulatory and accrediting agency requirements, prior to committee review and approval.
- Provide assistance in training of credentialing staff as required or applicable.
- Serves as a resource to the Medical Staff Coordinators on issues regarding credentialing for physicians and allied health professionals.
- Provide reports and status updates to regional medical staff offices or involved parties to ensure compliance.
- Support committees as assigned.
- Ensure consistent documentation and complete verification of practitioner (LIP/AHP) credentials.
- Provide required documentation to Chiefs of Service, Department Administrators, Medical Center Leaders and Committee Chairs/Members, as appropriate.
- Process credentials applications, initial and recredential.
- Process all applications for appointment/credentialing, reappointment/recredentialing via the local and regional medical staff/credentialing policies and procedures.
- Initiate investigation into applicants background, education, and experience through use of on-line systems, written correspondence, telephone inquiries and printed reference guides and reports.
- Process all applications for appointment/credentialing, reappointment/recredentialing via the local and regional medical staff/credentialing policies and procedures.
- Partner with all necessary staff to ensure an integrated, timely, consistent product.
- Collaborate with professional physician recruiters to monitor recruitment status of candidates to ensure timely credentialing prior to employment.
- Maintains computerized database of practitioner data for use in the medical staff service program to assure data for all credentialed and privileged practitioners is consistently accurate and current.
- Implements an efficient and effective communication system for transmission of electronic practitioner data to other users in the medical center for information (i.e., practitioner-specific privilege look-up for patient care units).
- Implements an efficient and effective communication/transmission system of shared data to regional or other local sites to facilitate timely approval for professional staff appointment or approval to participate within Southern California Region.
- Keeps abreast of laws, regulations, local and regional policies/procedures and Professional Staff Bylaws, Rules and Regulations.
- Maintains credentials files of all practitioners within medical center site (including satellite facilities/medical office buildings).
- Supports professional staff committees by preparing agendas, recording minutes, and follow-up.
- Supports the medical staff by being a resource for accreditation, licensing and regulatory compliance related to medical staff services functions.
- Leads and provides support, develops goals and program direction for projects.
- Sets agenda and conducts multi-disciplinary meetings and follows up on action items.
- Establishes team membership and negotiates time commitments.
- Designs and implements plans for data gathering and analysis.
- Partners with other departments to leverage community activities.
- Makes presentations to leadership audiences.
Basic Qualifications: Experience
- Minimum Five (5) years experience with credentialing in a hospital or ambulatory setting.
- AA degree or equivalent experience.
- N/A
- Proficient with medical terminology.
- Significant knowledge of Federal and State regulatory requirements and accreditation standards, e.g., TJC, Title XXII, NCQA, NPDB and certifying agencies.
- Strong organization and communication skills, attention to details required.
- Ability to lead and facilitate processes through influence and collaboration.
- Demonstrated problem-solving skills and initiative.
- Service oriented and the ability to work in a team environment required.
- Demonstrated ability to review practitioner credentialing files for accuracy and completion.
- Additional Skills: Proficient with IBM PC, Word, Excel, Access.
- Bachelors degree preferred.
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