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Job Type:
RegularScheduled Hours:
40Job Summary:
To administer the credentialing and privileging software application, used by Medical Affairs to house all provider sensitive and non-sensitive information that feeds and supplies multiple databases and is relied upon by multiple departments as primary source information. To administer the credentialing and privileging process for the Medical Staff/Allied Health Professionals and support the Medical Staff organization and its elected leaders in carrying out their appointed responsibilities.Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.
Job Description:
Plan, coordinate and implement security measures to safeguard information in computer files (application) against accidental or unauthorized damage, modification or disclosure. Assess application needs; improve application functionality; assure that data are secure and easily accessible; coordinate changes to application and continue to update knowledge of tools used to organize and store data.
- Oversee use, selection, and acquisition of software/modules.
- Correct errors and make necessary modifications.
- Train users and answer questions.
- Specify users and user access levels for each segment of database.
- Integrate different products so they work properly together, such as tailoring application to fit specific needs.
- Identify and evaluate product trends to serve as a source of information and advice for upper management as it relates to the purchase of additional programs and services.
- Build reports and queries for Administration, management personnel, and others, tailored for their specific needs. Generate reports to internal and external customers monthly.
- Educate / support end users on how to interact with electronic initial and reappointment process.
- Attend MD Staff User Conference and apply critical updates to the system.
- Create processes for increased utilization/functionality of MD Staff.
- Work closely with the marketing/web team on updates to the Find-A Doctor website.
- Update MD Staff manual as new features are introduced.
In compliance with The Joint Commission (TJC), HFAP, CMS, NCQA, Medical Staff Bylaws, and applicable Medical Staff or Board policies, administer the initial appointment, reappointment, FPPE, visiting physicians, credentialing and privileging processes for the Healthcare and Dearborn County Medical Staffs and Advanced Practice Providers.
This entails the following:
Coordinate the electronic transmission of initial appointment and reappointment information for both entities (Healthcare and Dearborn County Medical Staffs) Analyze the application and privileges requests. Determine areas of concern, gaps in information and any need for additional information. Obtain and evaluate primary source information based on
credentialing principles required by TJC, CMS, HFAP, NCQA, Bylaws, etc.
Obtain volume and competency data through appropriate resources. Identify competency and disparities with the privileges requested and information received on training and current competency. Serve as the primary contact for the applicant and the office staff during the credentialing process and provide initial orientation to the application. Work with the Medical Affairs Management and Medical Staff
leadership throughout the credentialing and privileging process.
Develop privileging criteria utilizing resources from the Clinical White Papers and professional societies. Complete SEP re-credentialing including primary source verification for 50% of St. Elizabeth Physicians and APPs in accordance with the Credentialing Services Agreement.
Work within the credentialing database to create provider profiles; assist with the development of delineation of privileges for new services and programs, create reports; maintain up-to-date information, including all expirables, and communicate database information to all involved departments and administrators of other databases for both entities (Healthcare and Dearborn County)
Information source for Medical and Advanced Practice Providers on hospital policies; Medical Staff Bylaws, Rules and Regulations and policies; and TJC/CMS/HFAP/NCQA requirements.
Performs other duties and special projects as requested and assigned.
Education, Credentials, Licenses:
- High school graduate
Specialized Knowledge:
- Knowledge of the software credentialing/privileges system.
- Organization and critical thinking skills necessary to analyze and make independent decisions on the appropriateness and acceptability of credentials files
- Understanding of, or ability to quickly grasp,
- credentialing principles.
- Knowledge of, or the ability to quickly grasp,
- Joint Commission and CMS Medical Staff standards.
- Excellent verbal, written and interpersonal
- communication skills.
- Excellent computer skills, including Microsoft Office
- Products (Word, Excel, Outlook, PowerPoint) and the ability to work with a database.
- Ability to multi-task and set priorities.
- Excellent customer service skills.
- Strong attention to detail.
Kind and Length of Experience:
- Two years credentialing experience or two years of hospital human resources experience.
DESIRABLE
- NAMSS Certified Professional Medical Services
- Management (CPMSM) or Certified Professional
- Credentialing Specialist (CPCS).
- Associate or bachelors degree in business or clinical field
- Knowledge of medical terminology preferred.
FLSA Status:
Non-ExemptRight Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.
