Credentialing and Contract Specialist

ST JOHNS HEALTH•Jackson, WY

5d•Onsite

About The Position

Provides administrative support to the SJH Medical Staff to contribute to the mission and goals of SJH as well as those outlined in the Medical Staff Bylaws, Rules & Regulations, DNV standards and other applicable Federal, State and local regulatory and/or accrediting agencies. Assumes primary responsibility for Medical Staff and other provider credentialing and meeting support. Delivers services according to the Scope of Service for Medical Staff Services. Adheres to the SJH Corporate Compliance Program and participates in performance improvement activities. Essential Functions 1. Credentialing ·Coordinates the Medical Staff, preceptee, and other provider credentialing processes, including billing and collecting Medical Staff dues, to assist the Medical Staff in assuring all individuals with clinical privileges provide services only within the scope of their training/licensing. ·Ensures the confidential files on medical staff members are up to date, reflecting the current status of medical staff standing and all expiring documents (category, board certification, privileges, dues, CME activities, etc.) ·Distributes initial and reappointment applications as per policy and upon receipt initiates primary source verification of information. Reviews applications for completeness and compliance with applicable policies and the Medical Staff Bylaws. ·Assembles all primary source verification information and prepares credentials file summaries for presentation to the Credentials Committee, Medical Executive Committee, Joint Compliance & Quality Committee, and the Board of Trustees. ·Actively maintains, develops, and updates skills and specific knowledge to implement ideal service. 2. Administrative Duties ·Establishes and maintains good communication with the Medical Staff, hospital administration, nursing staff, preceptees, and all hospital personnel. ·Provides support services to the Director of Medical Staff and Medical Staff members as requested. ·Attends continuing education programs in the field of Medical Staff Services, and when certified, maintains certification through the National Association of Medical Staff Services. ·Maintains an up-to-date practitioner database, including appropriate documentation, in the MD-Staff credentialing software. ·Has a working knowledge of the Medical Staff Bylaws, Rules & Regulations, applicable hospital policies, state/federal legal requirements, and DNV Medical Staff standards to provide updated information when needed. 3. Medical Staff Meetings ·Prepare the agendas, notices, and meeting packets for Medical Staff meetings as assigned. Attend Medical Staff meetings to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in a professional and effective manner. ·Attend the Credentials Committee, Medical Executive Committee, and Quarterly Medical Staff meetings, to serve as a resource on credentialing and privileging matters. Available to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in the absence of the Director of Medical Staff Services, when needed. 4. Additional Duties ·Work with Risk Management to aid in preparing and submitting SJH medical malpractice insurance applications to ensure continued coverage for employed, and some contracted, practitioners. Communicates effectively with the insurance carrier regarding policy initiation, renewal and any changes in coverage. ·Coordinate the dissemination of necessary information to the applicable hospital departments to ensure appropriate set-up of practitioners in the applicable hospital systems following approved changes by the Board of Trustees. ·Work with Hospital Administration staff to aid in the maintenance and updating of hospital contracts, when requested.

Requirements

Bachelor’s degree or a minimum of one year experience that is directly related to the duties and responsibilities, as specified, or a High School diploma/GED with at least two years’ experience that is directly related to the duties and responsibilities specified.
Two years of medical staff related experience, which may include administrative assistant responsibilities, proficiency in Microsoft Office Products, Acrobat X, and verbal/electronic communications.
Current NAMSS Certified Provider Credentialing Specialist (CPCS) certification. If not currently certified, must be actively seeking certification with the ability to become certified during the first testing cycle as soon as the minimum eligibility criteria outlined by NAMSS is met.

Nice To Haves

Membership and yearly continuing education through the National Association Medical Staff Services.
Experience in vetting, executing, and maintaining contracts.
Experience with the hospital credentialing processes, medical staff credentialing software, and quality performance software.
Previous experience working as a paralegal.

Responsibilities

Coordinates the Medical Staff, preceptee, and other provider credentialing processes, including billing and collecting Medical Staff dues, to assist the Medical Staff in assuring all individuals with clinical privileges provide services only within the scope of their training/licensing.
Ensures the confidential files on medical staff members are up to date, reflecting the current status of medical staff standing and all expiring documents (category, board certification, privileges, dues, CME activities, etc.)
Distributes initial and reappointment applications as per policy and upon receipt initiates primary source verification of information. Reviews applications for completeness and compliance with applicable policies and the Medical Staff Bylaws.
Assembles all primary source verification information and prepares credentials file summaries for presentation to the Credentials Committee, Medical Executive Committee, Joint Compliance & Quality Committee, and the Board of Trustees.
Actively maintains, develops, and updates skills and specific knowledge to implement ideal service.
Establishes and maintains good communication with the Medical Staff, hospital administration, nursing staff, preceptees, and all hospital personnel.
Provides support services to the Director of Medical Staff and Medical Staff members as requested.
Attends continuing education programs in the field of Medical Staff Services, and when certified, maintains certification through the National Association of Medical Staff Services.
Maintains an up-to-date practitioner database, including appropriate documentation, in the MD-Staff credentialing software.
Has a working knowledge of the Medical Staff Bylaws, Rules & Regulations, applicable hospital policies, state/federal legal requirements, and DNV Medical Staff standards to provide updated information when needed.
Prepare the agendas, notices, and meeting packets for Medical Staff meetings as assigned. Attend Medical Staff meetings to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in a professional and effective manner.
Attend the Credentials Committee, Medical Executive Committee, and Quarterly Medical Staff meetings, to serve as a resource on credentialing and privileging matters. Available to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in the absence of the Director of Medical Staff Services, when needed.
Work with Risk Management to aid in preparing and submitting SJH medical malpractice insurance applications to ensure continued coverage for employed, and some contracted, practitioners. Communicates effectively with the insurance carrier regarding policy initiation, renewal and any changes in coverage.
Coordinate the dissemination of necessary information to the applicable hospital departments to ensure appropriate set-up of practitioners in the applicable hospital systems following approved changes by the Board of Trustees.
Work with Hospital Administration staff to aid in the maintenance and updating of hospital contracts, when requested.