Medical Staff Services Professional
About The Position
The Medical Staff Services Professional, under general supervision, coordinates initial credentialing and re-credentialing processes. Reviews applications received from physicians and allied health professionals for completeness and accuracy, obtaining verification of licensure, education/training, board certification, malpractice claims history, disciplinary actions, and sanctions for presentation to the Credentials Committee. Maintain credentialing database by updating information received during initial credentialing and re-credentialing processes. Act as a liaison between the provider and medical staff/credentialing offices for purposes of obtaining medical staff membership and privileges. This is a full-time position, Monday through Friday.
Requirements
- High school diploma or equivalent required
- 3+ years in a hospital or managed care setting credentialing experience preferred
- Working knowledge of the National Association for Quality Assurance Standards and Guidelines for MCO accreditation
- Working knowledge of the credentialing process
- Familiarity with The Joint Commission Medical Staff standards and the requirements for credentialing and privileging
- Understanding/compliance of HIPAA laws and regulations
- Proficient in the use of Microsoft Word and Excel for Visual Cactus; NPI (National Practitioner Identification on-line access); IQRS (National Practitioner Data Bank on-line access); Certifacts (American Board of Medical Specialties on-line access); AMA Physician Masterfile on-line access; AOA Physician Profile on-line access; State licensing agencies on-line access and Internet Explorer for other internet access.
Nice To Haves
- Certification by the National Association of Medical Staff Services in Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) preferred
Responsibilities
- Process initial credentialing and re-credentialing applications for physicians and allied health providers.
- Review and analyze applications and credentialing documents for initial credentialing and re-credentialing, assessing completeness of information and qualifications to established standards.
- Identify and flag adverse information from application materials for the purpose of conducting special follow-up investigations in preparation for Credentials Committee review.
- Prepare, issue, track and follow-up on appropriate verification letters for adequate processing of each individual application, applying established procedural guidelines.
- Prepare completed credential files for presentation to Credentials Committee.
- Process requests to obtain membership and privileges for providers with hospitals, surgery centers, nursing homes, and other health care facilities.
- Respond to requests verifying provider’s affiliation with DMG.
- Enter data from provider applications into credentialing database, interpreting or adapting data to conform to defined data field uses.
- Perform bookkeeping activities for all primary source verification and credentialing expenses allocating to the appropriate division.
- Run data reports for various basic configurations of data such as provider profiles, pending provider lists and expired credentials.
- Assist Director in compliance with the accrediting and regulatory agencies (i.e., JCAHO, NCQA) in regard to credentialing while developing and maintaining a working knowledge of the statutes and laws.
- Assist Director in preparation for audits by health plans for delegated status.
- Internally audit, organize and maintain provider files and information in accordance with established principles of legal documentation, following confidentiality guidelines.
Benefits
- Medical, Dental, Vision, and many additional ancillary benefits EFFECTIVE DAY ONE
- 401(k) contribution options, with employer match up to 6%
- Access to Retirement Advisors
- Employer-paid Disability
- A Health Savings Account option with employer contribution
- Flexible Spending Account options, including Dependent Care FSA
- Rich Wellness Program and EAP, at no cost to the employee
- Fitness location memberships
- Pet care discount program
- Generous PTO allocation, increasing after 3 years
- 10 paid Holidays
- Up to 40 hours Paid Sick Time annually
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
