About this role
This is a Full-Time Position
Compensation Range: $ 61,214.40 to $91,832.00 yearly salary - paid biweekly
Exempt Position
Benefits: Medical, Dental, Life, Retirement, Paid Time Off
Ensures interpretation and compliance with the appropriate credentialing and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database systems and related applications.
ESSENTIAL FUNCTIONS AND BASIC DUTIES
Supervisory-Specific Performance Expectations, Duties, and Responsibilities:
• N/A
Position-Specific Performance Expectations, Duties, and Responsibilities:
• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research, and primary source verification of all components of the applicant's file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
• Prepares credential files for completion and presentation to MRH and Medical Staff Committees, ensuring file completion within specified time periods.
• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Assists with internal provider file audits.
• Monitors the initial, reappointment, and expired credentials process for all medical staff, Allied Health Professional staff, other health professional staff, and non-employed/delegated providers, ensuring compliance with regulatory bodies as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and contracts.
• Prepares meeting agendas and takes minutes for Medical Staff Committees.
• Utilizes credentialing software to maintain current records, licensures, and certifications.
• Organizes and facilitates the Peer Review process as needed. Maintains Peer Review documents in a locked file.
• Prepares confidential reports for the Medical Executive Committee (MEC).
• Establishes and maintains a professional relationship with all staff to resolve problems, working as a team.
• Functions in a high-volume, multiple-task environment, while producing quality work.
• Prioritizes workload and completes assignments within allotted time.
• Able to work independently and problem-solve.
• Must meet established productivity and quality guidelines.
• Attends all applicable workshops.
• Responsible for monitoring directed indicators.
• Performs other duties as assigned.
Organization-Specific Performance Expectations, Duties, and Responsibilities:
• Demonstrates full commitment to the CHOICE values of MRH and consistently represents the organization in a positive, professional manner.
• Establishes and maintains effective verbal and written communication, fostering positive working relationships with patients, staff, and vendors.
• Adheres to the MRH attire and dress code in accordance with organizational policies and procedures.
• Exhibits initiative and self-motivation; maintains a consistent level of productivity and manages time and responsibilities effectively.
• Completes all required annual education, training, in-services, and licensure/certification updates; actively participates in departmental and organizational meetings or reviews meeting minutes as required.
• Maintains strict patient confidentiality at all times.
• Reports to work punctually and completes assigned duties within established timeframes.
• Actively contributes to departmental and organization-wide performance improvement and continuous quality initiatives.
• Ensures compliance with all regulatory requirements, maintaining adherence to departmental, hospital, state, and federal standards and policies.
• Follows all infection control, safety, and risk management procedures to maintain a safe environment for patients, the public, and staff.
QUALIFICATIONS
• Must be at least 18 years of age (21 for positions requiring driving, with a valid driver's license).
• Must be legally authorized to work in the United States.
• Must successfully pass a background check.
• Must successfully pass a pre-employment drug screen and breath alcohol test (if applicable).
• Must complete an Employee Health meeting prior to starting employment.
EDUCATION, LICENSURE(S), AND CERTIFICATION(S)
Required
Preferred
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Bachelor's degree in Business Administration, Healthcare Administration, or related field.
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National Association Medical Staff Services (NAMSS) as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
EXPERIENCE
Required
Preferred
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One (1) year of experience directly related to hospital medical staff or managed care credentialing.