Senior Medical Staff Specialist

Kaiser Permanente-posted 3 months ago
Renton, WA
Ambulatory Health Care Services
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Independently requests and reviews primary source information and verifications. Identifies and plans for resolution of moderately complex gaps in vendor relationships and escalates, as needed. Serves as a main point of contact for external queries regarding practitioner status. Evaluates applications and supporting complex documents. Applies and begins to suggest improvements to credentialing and privileging processes. Evaluates moderately complex practitioner sanctions. Participates in surveys and audits of credentialing entities. Facilitates cost-effective due process. Conducts audits of data between different departments. Conducts the facilitation and orientation and training to newly appointed physician leaders. Develops moderately complex informational documents. Maintains working relationships with key stakeholders. Maintains awareness of policies and provides moderately complex consultations. Processes moderately complex provider enrollment information. Gathers and independently communicates relevant information to appropriate parties. Proactively ensures, guides others, and improves processes to enact control of data systems and applications. Independently analyzes data. Maintains moderately complex structures database structures and data.

  • Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members.
  • Builds relationships with cross-functional/external stakeholders and customers.
  • Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers.
  • Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses.
  • Leads by influencing others through technical explanations and examples and provides options and recommendations.
  • Adopts new responsibilities; adapts to and learns from change, challenges, and feedback.
  • Demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes.
  • Facilitates team collaboration to support a business outcome.
  • Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions.
  • Encourages team members to adapt to and follow all procedures and policies.
  • Collaborates cross-functionally and/or externally to achieve effective business decisions.
  • Provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate.
  • Monitors progress and results.
  • Supports the development of work plans to meet business priorities and deadlines.
  • Identifies resources to accomplish priorities and deadlines.
  • Identifies, speaks up, and capitalizes on improvement opportunities across teams.
  • Uses influence to guide others and engages stakeholders to achieve appropriate solutions.
  • Participates in training and regulatory awareness.
  • Independently facilitates orientation and training to newly appointed physician leaders.
  • Develops moderately complex informational/educational documents to communicate critical information regarding organizational programs and policies.
  • Independently develops and cultivates working relationships with key stakeholders.
  • Maintains awareness of current internal policies and relevant external regulations.
  • Provides moderately complex consultative expertise to internal parties.
  • Ensures quality assurance, improvement, and resolution by independently obtaining and evaluating moderately complex practitioner sanctions, complaints, and adverse data.
  • Participates in ongoing assessments of moderately complex governing documents to ensure continuous compliance.
  • Participates in surveys and audits of credentialing entities.
  • Independently facilitates efficient and cost-effective due process.
  • Identifies and escalates and prepares moderately complex adverse actions/issues to the credentialing committee.
  • Independently conducts audits and reconciliations of data between different departments.
  • Processes provider enrollment by gathering and performing detailed and thorough review of the moderately complex information used to submit the enrollment applications.
  • Independently prepares and submits data and applications to the contracted and government payors.
  • Independently communicates enrollment status to all stakeholders in a clear and timely manner.
  • May be notarizing public documents.
  • Conducts primary source verification and management by independently requesting, obtaining, and reviewing information from primary source verifications.
  • Identifies moderately complex gaps and opportunities in vendor relationships.
  • Independently verifies and documents expirables using acceptable verification sources.
  • Serves as main point of contact for external queries regarding practitioners status.
  • Conducts database management by independently maintaining moderately complex structures and data within a computerized data base.
  • Applies strategies to regularly maintain data structures, system functions, creations of workflows, portal management.
  • Interprets guidelines to enact auditing, assessing, procuring, implementing, effectively utilizing, and maintaining practitioner/provider and delegated credentialing processes.
  • Proactively identifies improvements to processes.
  • Enacts and analyzes data by independently ensuring efficient file completion.
  • Conducts privileging analyses and verifying privileging to the appropriate specialty/facility.
  • Independently completes evaluation of application and supporting documents for completeness.
  • Mentors team members to evaluate applications.
  • Prepares and completes complex documents related to practitioner-specific data.
  • Independently applies defined and may begin to suggest improvements to credentialing and privileging processes.
  • Minimum one (1) year(s) of experience in a leadership role with or without direct reports.
  • Minimum two (2) years of experience with databases and spreadsheets.
  • Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum three (3) years of experience in clinical credentialing, accreditation and regulation, licensing, health care, quality, or a directly related field OR minimum six (6) years of experience in clinical credentialing, accreditation and regulation, licensing, or a directly related field.
  • Provider Credentialing Specialist Certificate within 36 months of hire.
  • Negotiation
  • Compliance Management
  • Health Care Compliance
  • Health Care Data Analytics
  • Consulting
  • Managing Diverse Relationships
  • Delegation
  • Project Management
  • Health Care Quality Standards
  • Credentialling IT Application Software
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