Credentialing Specialist ( Job Number: 171052 )
Kaiser Permanente - Pasadena, CA

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Responsible for reviewing & auditing credentialing practices & processes standards; credentials & insures that all documents for providers/facilities are current. Develops & recommends action plans for facilities & Medical Staff Offices not meeting KP credentialing standards. Provides consultation & educational services, Permanente & at external contracted offices.

Essential Functions:
Audits credential files to insure compliance w/ regulatory & KP specific credentialing criteria & standards at all regional medical staff offices & regional credentialing
• Performs site visits at contracted facilities, audits files, & established procedures & processes to insure compliance w/ credentialing standards & regulations
• Prepares reports reflecting audit findings for submission to regional Credentialing & Privileging Committee & senior management detailing the compliance w/ KP credentialing standards; develops & recommends for adoption action plans for facilities and/or medical staff offices not meeting KPr's credentialing standards
• Responsible for maintaining & updating delegation agreements w/ non-KP facilities & other credentialing related files
• Provides consulting services to medical staff offices on credentialing standards & processes in complaince w/ regional policies & develops & conducts individual & group inservice training related to credentialing standards, regulations, & regianal policies
• Partners w/ medical staff office staff & appropriate hospital & medical group individuals to implement systems & processes that meet regulatory standards & regional credentialing policies & procedures
• Keeps abreast of changes in laws & regulatory requirements
• Implements internal processes & communication mechanisms that support organizational strategies & regional credentialing objectives
• Perfoms quality oversight of the credentialing process at assigned medical staff offices & at outside facilities
• Asists in preparations for regulatory surveys & audits by compiling data & reviewing files & other credentialing data to insure compliance w/ relevant standards
Qualifications

Basic Qualifications:
Three (3) - five (5) years of experience related to credentialing or accreditation in a hospital or ambulatory setting
• AA degree OR equivalent experience
• Bachelor's degree preferred
• Proficient in medical terminology
• Thorough knowledge of Federal, State, and certifying agencies regulatory requirements and accreditation standards, e.g., TJC, Title XXII, NCQA, NPDB
• Strong organization, written and communication skills: attention to detail required
• Ability to lead and facilitate processes through influence and collaboration
• Demonstrated problem-solving skills and initiative
• Service oriented and the ability to work in a team environment required
• Demonstrated ability to audit practitioner and provider credentialing files for accuracy and compliance with all regional, state and federal regulations
• Additional Skills: Proficient with PC, Word, Excel, Access, Lotus/Outlook
• Position requires travel throughout Southern California; must possess a valid California driver's license

Kaiser Permanente - 13 months ago - save job - block
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OVERVIEW America’s leading not-for-profit health plan, Kaiser Permanente serves more than 9 million people from 37 hospitals and 611...