Credentialing Coordinator - Full Time - Medical Staff Office (20181873) Tracking Code 20181873 Job Description JOB SUMMARY Responsible for assuring that the credentialing of practitioners is conducted in accordance with approved departmental credentialing policies & procedures, Medical Staff Bylaws and Rules & Regulations of hospital. REPRESENTATIVE DUTIES Supports the Credentialing and Privileging processes by providing efficient and effective operations of the administrative needs of the Medical Staff Office. Sends out application packets to potential applicants as requested by the Service Center Medical Directors including, but not limited to applications required for enrollment with contracted billing agencies/companies. Sends out applications to practitioners at time of reappointment as directed by the Service Center Medical Directors including but not limited to applications required for maintenance of enrollment with contracted billing agencies/companies. Receives credentialing and privileging materials, reviews for completeness and discrepancies/concerns prior to beginning the verification process and/or submitting appropriate material for enrollment with contracted billing agencies/companies. Generates (via letters/emails/web based communications, requests and/or queries) and tracks primary source verifications for credentialing process as required by the appropriate regulatory bodies as stipulated in the departmental credentialing policies & procedures, Medical Staff Bylaws and Rules & Regulations. Maintains current credentials of practitioners for the credentialing process and assists with data tracking activities in the medical staff office credentialing software. Produces routine information management reports and uses them to detect and resolve work-in-process problems. Assures the integrity of the practitioners information and verification source data when performing the data entry into the credentialing software for Collection and maintenance of an accurate practitioner database Practitioner master files are managed in accordance with procedures as outlined in credentialing policies & procedures. Controls the quality of the content and completeness of practitioner credentialing files. Assesses practitioner files to determine the presence or absence of potentially adverse information in accordance with guidelines established by the departmental credentialing policies & procedures, Medical Staff Bylaws and Rules & Regulations. Develops and maintains a good working rapport with members of the Medical Staff (i.e. Service Center Medical Directors, Medical Executive Committee), hospital executive/management team, other hospital personnel, representatives of regulatory agencies, as well as other outside individuals (i.e. locums agencies, representatives from other facilities). Advises the Director of the Medical Staff Office of outstanding issues requiring management intervention. Maintains working knowledge and compliance with departmental policies & procedures, Medical Staff Bylaws, Rules & Regulations, The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), as well as regulatory and accrediting bodies as deemed necessary by administration. Participates in the development and implementation of credentialing processes and procedures. Performs other duties as assigned. Required Skills Knowledge of business principles and practices. Knowledge of the principles and practices of organizational development. Knowledge of process improvement methods and measures. Knowledge of federal, state and local laws, codes and regulations. Knowledge of medical terminologies. Knowledge and use of credentialing software. Skill in assessing and prioritizing multiple tasks, projects and demands. Skill in verbal and written communication. Skill in organizing and documentation. Skill in operating fax, copier and a personal computer utilizing a variety of software applications i.e. MS Word, Outlook, Excel and PowerPoint. Skill in analyzing health systems issues, evaluating alternatives, and making recommendations. Skill in establishing continuous quality tracking, monitoring and improvement functions. Skill in establishing and maintaining cooperative and effective working relations with co-workers and representatives from other local, state and Federal agencies. Skill in working independently and maintaining confidentiality. Skill in maintaining quality, safety and infection control standards. Skill in maintaining a process that ensures the timely and accurate processing of applications for Medical Staff membership and the awarding of clinical privileges. Required Experience MINIMUM EDUCATION QUALIFICATION High School Diploma or GED. Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education. MINIMUM EXPERIENCE QUALIFICATION Non-supervisory - Three (3) years experience with practitioner credentialing in the health care industry. An equivalent combination of relevant education and/or training may be substituted for experience. PREFERRED CERTIFICATION QUALIFICATION Certification as a Certified Professional Medical Services Management (CPMSM), Certified Medical Staff Coordinator (CMSC) and/or a Certified Provider of Credentialing Services (CPCS) is preferred but not required. ADDITIONAL REQUIREMENTS Must obtain certification as Certified Professional Medical Services Management (CPMSM), Certified Medical Staff Coordinator (CMSC), and/or a Certified Provider of Credentialing Services (CPCS) within three (3) years of hire. MINIMUM PHYSICAL REQUIREMENTS The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to lift approximately 20 pounds and sit for long periods of time. ANMC is not a latex free environment. Therefore, some latex exposure can be expected. Job Location Anchorage, Alaska, United States Position Type Full-Time/Regular