Credentialing Specialist
HCPro.com - San Antonio, TX

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Located in Danvers, MA, The Greeley Company a division of HCPro, Inc. www.greeley.com

We are a nationally-respected consulting, training and education company known for providing practical, effective strategies and solutions to assist the leaders of today's healthcare organizations. Our consultants and educators are physician leaders and senior healthcare professionals with hands-on experience in hospital, ambulatory, physician practice, and managed care settings. We partner with nurses, physicians, and hospital clients to produce high-impact results that serve the best interests of their organization, their patients, and the communities they serve.

POSITION SUMMARY: Under the direction of the Coordinator/Manager/Director, MSSD, the Credentialing Specialist (CS) manages the functions required to support credentialing and privileging activities of the medical staff organization. Ensures that the credentialing and privileging activities of the medical staff organization meets all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation standards, state laws and Medicare Conditions of Participation. This includes, but is not limited to application management, verification of credentials, file maintenance (electronic and/or hard copy), and maintenance of expiring information, information management and direct support of the evaluation and decision-making process.

MAJOR COMPETENCIES:
The CS directly performs the following functions:
1. Practitioner Competency Management: = [75%]
Activities associated with this function include, but are not limited to coordination of application management and verification activities, red flagging potentially adverse information for medical staff leadership review, identification of areas where practitioners may not meet privileging or membership criteria.
• The Specialist shall also monitor expiring information such as: (DEA, license, professional liability insurance, specialty board certification status), maintain and update credentials files and the practitioner database.
• Preparation of practitioner information for review and evaluation of medical staff leaders and support of follow-up on actions taken by the medical staff organization with regard to practitioner competency management.
• Support of other competency management functions such as proctoring, focused and ongoing performance evaluations, etc. in accordance with bylaws, rules and regulations and policies and procedures.
• Works closely with department chairs and the Credentials Committee to define and delineate appropriate privilege forms and to assist in developing and establishing criteria for the granting of privileges.
• Assures that data entry of required source verification data elements and practitioner credentials files are managed in accordance with procedures as outlined in the MSSD Operations Manual.
• Effectively communicates issues and ongoing status of assigned work to Manager, MSSD.
2. Meeting Management and/or Agenda Support: [10%]
The CS directly performs the following functions, if assigned:
• The CS may be responsible for complete meeting management for one or more medical staff committees or for support of a specific agenda item.
• When the CS is assigned complete responsibility for meeting management the CS will be responsible for scheduling, agenda planning, support of chairs, in-meeting support, post meeting documentation and follow-up on items and tracking of issues between meetings for any assigned meetings that the CS is assigned to support.
• If the CS is not assigned responsibility for full support of the meeting, the CS will prepare for the portion of the agenda that is directed at credentialing functions and will support the assigned meeting manager as requested. The CS will assure that his/her assigned portion of the agenda is effectively supported and executed.
• Assure that all documentation reflects that required activities are undertaken by individual evaluators and meeting members and that relevant information is communicated to the MEC and board of directors who retain responsibility for oversight.
• Facilitate communication between medical staff organization and administration in matters that require cooperation.
• Effectively communicates issues and ongoing status of assigned work to Manager, MSSD.

3. Policies, Procedures and Documents = [15%]
In conjunction with the Director/Manager/Coordinator, assist in the maintenance and protection of medical staff records and documents.
4. Miscellaneous Office Tasks:
The CS may be assigned various tasks such as reception, filing, correspondence or other activities required to support the general operations of the Medical Staff Services Department.

Qualifications:

EDUCATION-At least a high school diploma

LICENSURE/CERTIFICATION- (required or achieved within [4] years)
NAMSS’ Certification (CPMSM and/or CPCS)

EXPERIENCE- 1+ years in industry setting (MSO, CVO, MCO)

The Greeley Company a division of HCPro is an equal opportunity/affirmative action employer; M/F/D/V are especially encouraged to apply.

HCPro.com - 20 months ago - save job - block
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Located in Danvers, MA, HCPro, Inc., www.hcpro.com is a leading provider of integrated information systems, analysis, and work flow...