Credentialing Specialist I

Description

The Credentialing Specialist performs the initial and reappointment credentialing process, and ensures compliance with the Medical Staff credentialing requirements. In addition, this position is responsible for making recommendations on improvements to the credentialing policies and procedures, based on experience and/or evolving regulatory requirements (i.e. Federal, State and Joint Commission). The Credentialing Specialist will serve as the focal point for credentialing process, distribute and receive applications and reappointment, analyze applications and reappointment and perform primary source verification, prepare files for review, monitor and document credentialing efforts, serve as knowledge expert on credentialing, monitor credentialing status of applicant, continuously improve the credentialing process, and perform general administrative support tasks as needed. Major challenges of this position include managing a high volume of work with critical deadlines, analyzing complicated applications for thorough and current information, and staying abreast of frequently changing internal policies and procedures and external standards and requirements.

Core Competencies

• Assembles and provides application and reappointment applications to physicians, independent and dependent health practitioners and ensure correct procedure have been applied to eligibility criteria, as defined by the medical staff (ie Medical Staff Bylaws, Rules and Regulations, Policies/Procedures).
• Applies credentialing standards and techniques to process initial request for medical staff privileges.
• Processes all medical staff applications in accordance with Medical Staff Bylaws and procedures.
• Assesses requests for clinical privileges by applying credentialing criteria.
• Ensures that physicians are not presented to the medical staff for evaluation of clinical privileges to perform procedures that they have not been trained to perform or do not have current clinical competence to perform.
• Enters all applicant data into computer.
• Maintains a log of mailed applications, including return date.
• Prepares files of physicians requesting privileges for review by the Credentials Committee, clinical department and other appropriate committees.
• Assists Medical Staff Coordinators in review of the application/credential files with attention to issues of concern (red flags) or questions that require detailed evaluation by the department chief.
• Assists with training of Medical Staff Coordinators in use of credentialing software, including development of automated forms, and other necessary documentation with development of spreadsheets as needed.
• Prepares a report for the Board of Trustees of medical staff applicants, resignations, deaths and physicians in violation of medical staff bylaws, etc
• Prepares and distributes monthly staff status changes to all departments within Torrance Memorial.
• Prepares correspondence to inform physicians of decisions of Credentials Committee, Executive Committee and the Board of Trustees.
• Assists Vice President with notification of proper state/federal agencies of reportable actions taken against an applicant as needed.
• Maintains current Department Rules and Regulations and privilege cards (forms) for assigned departments in conjunction with the initial application process.
• Maintains equipment and work area per department policies and procedures.
• Assists with orientation and training of new employees and volunteers as assigned.
• Utilizes appropriate and effective communication and problem solving skills in all interpersonal interactions.
  
  
  

Experience

Additional InformationMinimum of two years of experience in medical staff services, appropriate medical center clerical experience, or administrative clerical experience. Medical terminology. Proficiency with PC-based software.

Compensation Range

$30.24 - $46.20 / Hour