Senior Medical Staff Credentialing - Full Time - Day

Hackensack Meridian Health•Holmdel Township, NJ

2d•$29•Onsite

About The Position

The Senior Medical Staff Credentialing Specialist is responsible for the integrity of all aspects of the credentialing cycle. This role collaborates with Centralized Verification Office and Medical Center leaders to promote practitioner advocacy, departmental effectiveness, and regulatory readiness and to ultimately ensure we have the most qualified providers for patient safety. This position serves as a subject matter expert for the department, providing guidance to team members, managing complex cases, and leading quality improvement initiatives.

Requirements

Associate's degree or a combination of education and/or 4 years of prior credentialing or hospital medical staff office experience.
Minimum of 3 years of credentialing experience in a Hospital Medical Staff Office with knowledge of medical credentialing and privileging procedures and standards, as well as knowledge of related accreditation and certification requirements.
Exercises a high degree of initiative, judgment, discretion, and decision-making skills to achieve objectives.
Excellent written and verbal communication skills.
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Nice To Haves

Previous experience with credentialing databases.
NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).

Responsibilities

Serves as the lead point of contact for medical staff office team members and physicians with difficult situations, resolving challenges with credentialing, answering questions, intervening with physician concerns.
Assists with training and guiding new medical staff office team members.
Audits credentialing files prepared by other team members to ensure accuracy, consistency, and compliance with regulatory standards.
Collaborates with the Centralized Verification Office (CVO) to ensure effective and efficient initial and/or reappointment process for all applicants to the Medical and Dental Staff ensuring compliance with regulatory bodies (The Joint Commission, CMS, federal and state), as well as the Medical Staff Constitution and Bylaws and Rules and Regulations.
Functions as the primary onsite specialist to correct, clarify, and complete the initial appointments of providers.
Works closely with Department Chairs, administrators, physicians and applicants to facilitate resolution of credentialing issues and concerns.
Maintains and organizes all information needed for the credentialing process. As needed, researches and conducts primary source verification for all components of the credentialing file.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Identifies opportunities for process improvement and assists the Manager in developing and implementing updated policies and workflows.
Prepares credentials files for presentation to the Credentials Committee, flagging any issues the Committee and/or Chair may need to be alerted to.
Facilitates Credentials Committee meeting with the committee chair to review agenda issues prior to the committee meeting.
Assigns reviewers for each applicant prior to Credentials Committee meeting and provides files and material to reviewer. Follows up on any questions reviewer might have, obtaining additional information from applicant or outside sources.
Processes requests for privileges, ensuring compliance.
As appropriate and in accordance with TJC standards, conducts Ongoing Professional Practice (OPPE) using the HMH selected vendor.
As appropriate, follows up on OPPE outliers with the Section Chief and or Department Chair.
As appropriate and in accordance with TJC standards, assists with preparing the Focused Practice Professional Evaluation (FPPE) Plan with the Section Chief and or Department Chair.
As appropriate, follows-up on the FPPE plan to be sure all elements are completed.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
Utilizes credentialing database, optimizing efficiency, and performs query, report and document generation.
Documents all actions of the Credentials Committee.
Processes all actions following approval by the Board of Trustees.
Processes temporary privileges for new staff members.
Processes necessary documentation and submits for temporary privileges, resignations, status changes, new access etc.
As appropriate, verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Takes appropriate actions when the practitioner is out of compliance.
Participates in surveys and audits of regulatory and accreditation agencies or organizations.
Obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance.
Assists applicants and their departments with leaves of absence and resignations.
Coordinates with Human Resources in onboarding for new members of the medical staff.
Reviews Sanction sites for practitioner license/managed care actions.
Collaborates with Manager and Department Chairs and other key staff members in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven.
Performs other duties as required.
Processes requests for change of collaborating/supervising physician agreements.
Coordinates with Team Health, Human Resources, Risk Management, Chairs, Administrators to bring the credentialing process to completion.
Provides support and works in conjunction with the CMO and medical staff leadership as needed.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.