This is an onsite position.
POSITION SUMMARY:
Coordinates the activities of the Credentialing Program in compliance with state, federal and Joint Commission standards. Coordinates the activities of the Credentials Committee. Provides executive administrative support to various medical staff departments/services related to the Medical Staff Office, medical staff meetings, medical staff leaders, and the CT Regional CMO & Senior Vice President for Medical Affairs.
EDUCATION/CERTIFICATION:
Associate degree required. Bachelor's degree preferred.
National Association Medical Staff Services Certification in Professional Medical Services Management (CPMSM) required. If not certified upon hire, must obtain certification within one year after eligibility.
Must possess and maintain a valid driver's license and an acceptable driving record in accordance with organizational policy.
EXPERIENCE:
Minimum five (5) years of hospital credentialing experience.
COMPETENCIES:
Consistently demonstrate the Organization's Core Values: Caring, Teamwork, Respect, and Communication.
Self-directed and self-motivational skills with a strong attention to detail.
High level professional written and verbal communication skills.
Mature attitude and judgment; responsible; professional demeanor and appearance, patient and flexible.
Ability to manage multiple priorities from initiation to completion within prescribed schedules.
Responsible for the accuracy and integrity of the credentialing database system and related applications.
Ability to analyze, interpret and draw inferences from research findings and present recommendations to the medical staff leaders for credentialing and privileging issues.
Must have strong customer service skills and make applicants to the medical staff a high priority customer.
Professional level contact with physicians, health system executives, directors, managers, and attorneys.
Must be proficient in the use of Windows based Microsoft office software applications.
Advanced knowledge of credentialing database software is preferred.
Advanced knowledge of state, federal and Joint Commission medical staff standards.
Fundamental understanding of Medical Terminology.
Schedule flexibility to attend required events/meetings in the early morning or in the evening to accommodate physician schedules.
Must have access to reliable transportation to travel between multiple work sites; and travel is required in order to perform essential duties.
ESSENTIAL DUTIES and RESPONSIBILITIES:
Disclaimer: Job descriptions are not intended, nor should they be construed to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time.
Collaborates with medical staff leaders and coordinates the Medical Staff and Advanced Practice Professional staff credentialing and privileging program. Processes requests and performs primary source verifications for appointment, reappointment, clinical privileges, and temporary privileges in accordance with medical staff bylaws, Joint Commission standards, state, and federal regulations. Creates and maintains all Medical and Advanced Practice Professional staff credentials and peer review files in compliance with policy. Complies with the policy on Confidentiality of Medical Staff Records and Files.
Coordinates the functions of the Credentials Committee. Prepares meeting agenda, attends, and participates at meetings and records minutes. Prepares complete credentials files for recommendations and Committee review/approval. Identifies files with questionable information and reviews with the Committee Chair prior to Committee meetings to determine the next steps. Completes all follow-up actions including correspondence of the Committee through to final action by the Medical Executive Committee and the Board of Trustees. Collaborates with the Organization's legal counsel and outside legal counsel to resolve credentials related issues.
Coordinates the activities of the Medical Staff Bylaws Committee.
Coordinates the full medical staff meetings.
Collaborates with department chairs/service chiefs in the development of privileging criteria for new procedures.
Develops policies and procedures pertaining to credentialing functions. Monitors Joint Commission standards and state and federal regulations for changes that impact medical staff bylaws and credentialing policies. Assists in bylaw language development. Evaluates current policies and procedures for required updates and creates new policies as needed.
Collaborates on the monitoring of monthly expiration of Medical and Advanced Practice Professional staff state licenses, federal and state drug control registrations, professional liability insurance and board certifications. Monitors the collection of renewed licenses, registrations, insurance, and certification documents in accordance with policy.
Participates in Joint Commission accreditation, CMS, and Connecticut State licensure inspection surveys.
Acts as system administrator for the credentialing software database and maintains accurate Physician and Advanced Practice Professional information in credentialing database, hospital database and CHIME database. Responsible for training staff in the use of the credentialing software database and other databases as appropriate.
Responds to inquiries from other health care institutions, managed care organizations and internal departments regarding Medical and Advanced Practice Professional staff in accordance with policy.
Creates reports using the credentialing database for the Credentials Committee, the Medical Staff and hospital departments. Provides information for various hospital publications, website, and the state-wide disaster credentialing database.
Attends education seminars related to credentialing to maintain knowledge and compliance with standards and regulations. Earns continuing educational credits to maintain certification. Networks with other credential professionals within CT and outside of CT.
Participates and collaborates in the monthly Credentials Workgroup. Tracks credentialing issues that need to be addressed. Uses tracking tool to develop annual goals.
Monitors credentialing and professional services related agreements and prepares amendments. Reviews new agreements and negotiates terms.
Monthly monitors Meditech Provider Dictionary on-staff and non-staff providers for office of inspector general (OIG) sanctions. Reports actions taken against staff providers to the appropriate individuals in accordance with policy.
Prepares communications to new Medical Staff and Advanced Practice Professional Staff related to mandatory education and/or requirements and monitors compliance including but not limited to HRO Training, Safety Absolute Education, Flu and COVID Vaccination Programs.
Annually assigns and de-assigns residents hospital DEA numbers and medical dictation numbers.
As required by law and regulation, reports adverse actions and medical malpractice payments to the National Practitioner Data Bank and State of CT Department of Public Health.
Monitors and develops annual report of signed Medicare Acknowledgment statements for CMS compliance.
Coordinates additions, deletions, and annual updates of the physician referral database for the physician referral program.
Collaborates with medical staff leaders and coordinates the medical staff officer election process and nominating committee functions.
Collaborates and assists medical staff leaders with preparation for hearings in accordance with medical staff bylaws. Participates in discussions with attorneys regarding bylaw's process and procedure.
Prepares letters and memos and sends communications to the medical staff via e-mail, mail, or other available means, when necessary.
