Category:

Admin Support

City:

Jackson

State:

Tennessee

Shift:

8 - Day (United States of America)

Job Description Summary:

Under direct supervision of the Director of Medical Staff Services, the credentialing specialists carries out the responsibilities of Medical Staff Services following the credentialing guidelines established by the Hospital, the Medical Staff, The Joint Commission, the Centers for Medicare and Medicaid as well as other regulatory agencies and credentialing agreements. The Credentialing Specialist must complete timely and accurate credentialing of providers with minimal guidance. The Credentialing Specialist must apply critical thinking skills in processing applications and in communicating with applicants. The credentialing specialist coordinates and processes all medical staff and health professional affiliate applications for appointment/reappointment for assigned areas of responsibility, according to established guidelines. The credentialing specialist coordinates provider’s initial application and reappointment application for the organization in accordance with the Joint Commission on the Accreditation of Health care Organizations (JCAHO) standards, state and federal regulatory agencies in accordance with the Medical Staff Bylaws, procedures and Rules and Regulations, in order to assure that only qualified practitioners and Health Professional Affiliates, under direct supervision of their sponsoring physician, provide care in the hospital. The credentialing specialist will assist with mentoring and training of other staff as necessary in all aspects of the credentialing process. Employee is subject to call back and overtime as required by the hospital.

ESSENTIAL JOB FUNCTIONS:

• Provides support to and works cooperatively with Medical Staff.
• Works proactively to resolve issues before providers and/or patients are impacted.
• Initiates letters of inquiry regarding education, training, personal medical references, staff affiliations, board certifications, out-of-state licensure and relevant information.
• Requests verification from the state Medical Boards for current state licensure. Queries the National Practitioner Databank.
• Conducts thorough background investigation, research and primary source verification of all components of the application. 
• Performs primary source verification of all necessary elements through letters, emails, faxes, or websites.
• Follows up on incomplete or problematic information in a timely and consistent manner.
• Ensures that all reappointments are completed and reviewed by the appropriate credentialing entity before expiration date. 
• Tracks license and certification expiration for all providers to ensure timely renewals.
• Performs technical and complex credentialing, privileging, and clerical duties (in accordance with established credentialing policies), to the chairman of each of the medical staff departments, as well as the Chairmen of the credentials committee. Thus assisting them in carrying out their responsibilities as outlined in the Medical Staff Bylaws, procedures, Rules and Regulations and to ensure compliance with these documents and standards/requirements of other regulatory agencies, involving independent judgment and understanding of credentialing and privileging functions and procedures.
• Gathers data from various sources to meet defined criteria and enters into database.
• Assists in all activities related to the Department in areas of safety training compliance and other areas of responsibility as assigned to assure that all Department functions are accomplished a timely/required manner.
• Responsible for maintaining data, data entry, data reports and coordination of all IS function within the department.  Responsible for assessing the IS needs of the department and making recommendations to the director for current and future IS needs.
• Responsible within department for information/pictures/signatures for hospital intranet and for hospital internet Physician lists. Coordinates information with IS department and PR department to supply required information for hospital website and for hospital internet.  
• Primarily responsible for scanning of documents and document storage.
• Responsible for scanning of documents for affiliate hospitals for credentialing meetings and for surveys.
• Processes requests for, and monitors duration of, all categories of privileges in accordance with policies and procedures of the Medical Staff Bylaw and Rules and Regulations.
• Assists in providing administrative support to the Medical Staff/Medical Staff Affiliates initial credentialing and privileges delineation activities in accordance with the Medical Staff Bylaws, and Rules and Regulations so as to assure that only qualified practitioner provide care in the hospital.
• Performs duties in a timely, comprehensive, well-organized manner.
• Maintains personal adherence to professional confidentiality standards established within the department and in accordance with legal, ethical and hospital policies.
• Assures data security and confidentiality by use of appropriate labeling of information and storage of information.
• Contributes to a positive work climate and the overall team effort of Medical Staff services.
• Assists in the reply to requests for information verification from outside sources.
• Performs related responsibilities as required or directed.

JOB SPECIFICATIONS:

EDUCATION:

• Completion of a Baccalaureate degree in Medical Staff Services Science preferred or equivalent work experience will be considered
• Knowledge of medical terminology

LICENSURE, REGISTRATION, CERTIFICATION:

• N/A

EXPERIENCE:

• Computer programs, electronic databases, and internet experience is essential.
• Three years’ experience in Credentialing Services or related field will be considered.
• Experience with heightened understanding of the medical staff organizational structure and hospital operations.
• Advance knowledge of office procedures and equipment, filing systems, composition and formatting of reports. 

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.