Credentialing Specialist - Main Medical Staff Office Job Cincinnati area,Ohio USA,Healthcare

Position: Credentialing Specialist - Main Medical Staff Office - Full Time - Days

Job Description

Responsible for coordination and preparation of medical staff functions; prepares for committee meetings, takes 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 compliance with accrediting and regulatory agencies (Joint Commission and NCQA) in regard to credentialing and privileges while developing and maintaining a working knowledge of statutes 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 managing the flow of information between medical staff services, Credentials Committee, MEC Committee, medical staff leadership, and Chief Medical Officer. Manages the FPPE process and the integration of OPPE during reappointment.

Responsibilities

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 federal and state law, regulatory and accrediting agencies:

Upon receipt of applications (initial and reappointment), determine if the application meets criteria and whether to initiate the verification process and documentation, according to policies.
Initiate and prepare all required primary source documentation such as AMA and NPDB, etc.; and follow‑up as necessary with providers.
Monitor information collection and perform cognitive analysis of all information received; evaluate adequacy and quality, pursue additional information as needed.
Coordinate, perform and maintain a tracking system for the process to ensure continuous processing of applications, reporting to Manager as needed.
Upon completion of the credentialing process, update all relevant files and listings, credentialing database per policies and procedures and file credentialing files accordingly; ensure clinical privileges are available online for TCH staff to ensure providers are practicing within their scope of privileges.
Prepare written notification of Board action to appropriate personnel/practitioners.
Initiate Focused Professional Practice Evaluation and assist with the Ongoing Professional Practice Evaluation for practitioners according to policy and procedures.
Assist department directors or section chiefs to establish criteria for privileging.
Initiate and maintain proctoring of applicants as required with follow‑up.

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

Attend meetings.
Provide meeting minutes and maintain minutes history.
Notify members of meetings.
Prepare meeting agenda/handouts, and follow‑up to include coordination of actions taken.
Provide coverage for the Medical Executive Committee and others as directed.

Process requests for temporary privileges and monitor all follow‑up, according to policies and procedures:

Communicate relevant information to applicant and appropriate hospital personnel.
Distribute appropriate paperwork.
Establish and maintain necessary files.

Process requests for additional privileges and monitor all follow‑up, according to policies and procedures:

Upon receipt of additional privilege application, initiate the verification process and documentation, according to policies.
Initiate and prepare all required primary source documentation, including NPDB, etc.; and follow‑up as necessary with providers.
Maintain a tracking system for the process to ensure continuous processing of applications, reporting to Manager as needed.
Upon completion, update all relevant files and listings, credentialing database per policies and procedures and file credentials accordingly; ensure clinical privileges are available online for TCH staff.
Prepare written notification of Board action to appropriate personnel/practitioners.
Communicate relevant information to applicant and appropriate hospital personnel.
Distribute appropriate…