CREDENTIALING SPECIALIST

Los Angeles County (CA)•Los Angeles, CA

67d

About The Position

The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. DHS operates as an integrated health system, operating 25 health centers and four acute care hospitals, in addition to providing health care to youth in the juvenile justice system and inmates in the LA County jails. Across the network of DHS' directly operated clinical sites and through partnerships with community-based clinics, DHS cares for about 500,000 unique patients each year, employs over 23,000 staff, and has an annual operating budget of 8.4 billion. For additional information regarding DHS please visit www.dhs.lacounty.gov. Through academic affiliations with the University of California, Los Angeles (UCLA), the University of Southern California (USC), and the Charles R. Drew University of Medicine and Sciences (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In addition, to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency response system, as well as Housing for Health and the Office of Diversion and Re-entry, each with a critical role in connecting vulnerable populations, including those released from correctional and institutional settings, to supportive housing. DEFINITION: Provides support in the process of obtaining, verifying and assessing the qualifications of physician and allied health professionals to provide patient care services. CLASSIFICATION STANDARDS: Under general supervision, positions allocable to this class are responsible for collecting, reviewing, monitoring, and updating credentialing documentation for existing and the appointment of new medical providers. Incumbents follow policies and procedures, established by departmental by-laws and regulatory agencies, to evaluate and verify professional licensure, education, training, experience, competencies and hospital affiliations to ensure that medical providers are appropriately qualified and privileged. Incumbents in this class are required to serve a one-year probationary period. Positions allocated to the Department of Health Services report to the Medical Staff Coordinator of a hospital, or a Physician in a Multi-Service Ambulatory Care Center. Positions allocated to the Department of Mental Health typically report to a higher-level manager and are responsible for processing and maintaining credentialing documentation for review by the credentialing review committee.

Requirements

Three (3) years of recent, full time experience in a Medical Staff Services office at the level of the Los Angeles County class of Intermediate Typist Clerk or higher.
A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.
Successful certification as a Certified Provider Credentialing Specialist issued by the National Association of Medical Staff Services will be required before final appointment.

Nice To Haves

Additional credit will be awarded for experience beyond the Selection Requirements.

Responsibilities

Receives and processes applications for credentialing and privileging from licensed independent practitioners and allied health professionals applying for membership in the Professional Staff Association (PSA); notifies the respective department chair and the applicant of their status and time frames for completion.
Reviews applications for required documentation; verifies credentials, education, employment history, licensure, professional references, hospital affiliations and liability claims history by performing on-line queries from a variety of resources, such as the National Practitioner Data Bank, American Medical Association, Drug Enforcement Administration, and Office of the Inspector General.
Ensures physicians, allied health professionals and other practitioners of a healthcare facility are properly licensed, trained, and certified as mandated by state and federal regulations.
Reviews requested privileges to ensure that appropriate criteria and training is documented for the privileges sought.
Monitors documentation of provisional applications for completion of proctoring; notifies the respective department chair and provisional members regarding their status and time frames for completion of proctoring.
Prepares summary report of each application for evaluation and review by the Credentials and Medical Executive Committees; identifies any potential adverse information.
Maintains application and credentialing files in a confidential manner; regularly enters credentialing information into the database to ensure information on credentialing, privileging, certifications, prerogatives and competencies are current; disseminates data to authorized personnel.
Prepares reports or credential files for periodic audits by Consolidated Accreditation and Licensure Survey and Office of Managed Care as requested; conducts internal reviews; and completes required tasks as necessary.
Generates letters to hospital affiliations and other agencies to obtain information of the practitioner's professional competency. Responds to inquiries from other agencies requesting employment verification and relevant information on current and past members of the PSA.
Prepares reports for various committees as requested on a periodic basis.
Participates in the development and implementation of credentialing processes and procedures.