Credentialing Analyst : Medical Staff Office

Hoag•Newport Beach, CA

10d

About The Position

The Credentialing Analysts possess specialized, high-level expertise that is applied to meet the internally established quality metrics and to comply with external accreditation standards, state laws and Medicare Conditions of Participation. The Credentialing Analysts are expected to perform all credentialing-related functions and follow-up, working independently with minimal oversight. These positions develop reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors. The Credentialing Analyst processes applications for initial appointments and/or reappointments of health care providers. The incumbents shall review applications, prepare verification letters and maintain Medical Staff database while also contacting primary source verifications, licensing agencies, insurance carriers, and other references required by the Medical Staff. Process all applications for Medical Staff and Allied Health Staff. This includes the collection and maintenance of all required information, including, but not limited to primary source verifications, licensing agencies, insurance carriers, other references, and clinical activity reports. Compare collected credentialing information against regulatory and accrediting standards to determine adherence to those standards. Prepare practitioner information for review and evaluation by medical staff leaders and support of follow-up on actions taken by the Medical Staff organization with regard to practitioner competency management. Conduct quality control activities to determine regulatory/accrediting compliance and level of achievement to established performance goals and exercise sound, independent decision-making to take action necessary to correct deficiencies. Design processes to promote continuous readiness for various regulatory and accrediting surveys

Requirements

High School diploma, GED, California High Proficiency or equivalent work experience
Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)

Nice To Haves

MD Staff experience preferred
Proficiency with medical terminology preferred
Certified Professional Credentialing Analyst (CPCS)
Certified Professional Medical Services Professional (CPMSM)

Responsibilities

Perform all credentialing-related functions and follow-up, working independently with minimal oversight.
Develop reports for meetings, including the credentials report for presentation to the Credentials Committee, Medical Executive Committee and Board of Directors.
Process applications for initial appointments and/or reappointments of health care providers.
Review applications, prepare verification letters and maintain Medical Staff database while also contacting primary source verifications, licensing agencies, insurance carriers, and other references required by the Medical Staff.
Process all applications for Medical Staff and Allied Health Staff.
Collect and maintenance of all required information, including, but not limited to primary source verifications, licensing agencies, insurance carriers, other references, and clinical activity reports.
Compare collected credentialing information against regulatory and accrediting standards to determine adherence to those standards.
Prepare practitioner information for review and evaluation by medical staff leaders and support of follow-up on actions taken by the Medical Staff organization with regard to practitioner competency management.
Conduct quality control activities to determine regulatory/accrediting compliance and level of achievement to established performance goals and exercise sound, independent decision-making to take action necessary to correct deficiencies.
Design processes to promote continuous readiness for various regulatory and accrediting surveys