Medical Staff Services Professional

District Medical Group•Phoenix, AZ

3d•Onsite

About The Position

District Medical Group (DMG) is a nonprofit, integrated multi-specialty medical group in Phoenix, Arizona with a reputation for outstanding leadership, innovation, and dedication to the patients and communities we serve. DMG employs over 750 members, including Physicians, Advance Practice Providers, independent contractors, executives, and administrative staff to provide services across all major medical specialties and subspecialties. We are proud of the commitment to patient care, education, research, and community health services the organization has supported for over 30 years. DMG Offers the Complete Experience By upholding a supportive work environment through employee appreciation, collaboration, mentoring, and growth opportunity, DMG has retained countless long-tenured staff and welcomes new knowledge and initiatives. The organization offers a benefits package that includes competitive compensation and attractive health and company benefits, highlighted below. 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.

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
Proficient in 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