Credentialing Specialist - Main Medical Staff Office

Job Description

Responsible for coordination and preparation of medical staff functions; prepares for committee meetings, taking minutes, processes and distributes appropriate correspondence and assists with the development, planning and implementation of the credentialing and privileging process in addition to the analysis of each file upon completion. Assists in the compliance with the accrediting and regulatory agencies (i.e., Joint Commission and NCQA) in regards to credentialing and privileges while developing and maintaining a working knowledge of the statues and laws.

Ensures that all expirables are reviewed, obtained and managed on a monthly basis according to the rules and policies. Maintains the confidentiality of all business/work and medical staff information. Assists in the managing the flow of information between medical staff services, Credentials Committee and MEC Committee, medical staff leadership and Chief Medical Officer. Manages the FPPE process and the integration of OPPE during reappointment.

1. Coordinate the credentialing activities of the Medical Staff and Allied Health Staff, in accordance with the Medical Staff Bylaws, Credentialing Policies and Procedures of The Christ Hospital (TCH) as well as the federal and state law, regulatory and accrediting agencies:

A. Upon receipt of applications (initial and reappointment), determine if application meets the criteria and whether to initiate the verification process and documentation, according to policies;

B. Initiate and prepare all required primary source documentation such as American Medical Association (AMA) and National Practitioner Data Bank (NPDB), etc; and follow-up as necessary with the providers.

C. Monitor information collection and perform cognitive analysis of all information received; evaluate adequacy and quality, pursue additional information as needed.

D. Coordinate, perform and maintain tracking system for process to ensure continuous processing of applications, reporting to Manager, as needed;

E. Upon completion of credentialing process, update all relevant files and listings, credentialing database per policies and procedures and file credentialing files accordingly; and ensure clinical privileges are available on-line for TCH staff to ensure providers are practicing within their scope of privileges.

F. Prepare written notification of Board action to appropriate personnel / practitioners.

G. Initiate Focused Professional Practice Evaluation and assist with the Ongoing Professional Practice Evaluation for practitioners according to policy and procedures.

H. Assist the department directors and/or section chiefs to establish criteria for privileging.

I. Initiate and maintain proctoring of applicants as required with required follow-up.

2. Provide administrative support to Credentials, General Staff and other Medical Staff committees and departments of TCH as directed:

A. Attend meetings;

B. Provide meeting minutes, and maintain meeting minutes history (three-ring binders and/or on shared drive of medical staff services);

C. Notify members of meetings;

D. Preparation of meeting agenda / handouts, and follow-up to include coordination of actions taken;

E. Provide coverage for Medical Executive Committee, and others, as directed.

3. Process requests for temporary privileges and monitor all follow-up, in accordance with policies and procedures:

A. Communicate relevant information to applicant and appropriate hospital personnel;

B. Distribute appropriate paperwork;

C. Establish and maintain necessary files.

4. Process requests for additional privileges and monitor all follow-up, in accordance with policies and procedures:

A. Upon receipt of additional privilege application, initiate the verification process and documentation, according to policies;

B. Initiate and prepare all required primary source documentation, including National Practitioner Data Bank (NPDB), etc; and follow-up as necessary with the providers.

C. Maintain tracking system for process to ensure continuous processing of applications, reporting to Manager, as needed;

D. Upon completion of credentialing process, update all relevant files and listings, credentialing database per policies and procedures and file credentialing files accordingly; ensure clinical privileges are available on-line for TCH staff to ensure providers are practicing within their scope of privileges.

E. Prepare written notification of Board action to appropriate personnel / practitioners.

F. Communicate relevant information to applicant and appropriate hospital personnel;

G. Distribute appropriate paperwork;

H. Establish and maintain necessary files.

I. Initiate FPPE for all additional privileges.

5. Process requests for one-time privileges, visiting physicians and/or student observers.

A. Initiate primary source verification if applicable.

B. Maintain tracking system for process to ensure continuous processing of applications, reporting to Manager, as needed;

C. Upon completion, obtain appropriate…