Oversee all aspects of the timely credentialing and re-credentialing of 800+ medical, dental and ancillary professional staff according to Medical Staff Bylaws and departmental policies and procedures.  Responsibilities include, but are not limited to:

• Assisting applicants with the completion of the appointment/reappointment applications.
• Follow-up with applicants on missing documentation and preparing files for applicable department and hospital committee approvals.
• Act as liaison between applicants and hospital departments such as Human Resources, Employee Health, etc.
• Support medical staff committees as needed.

MAJOR ACCOUNTABILITIES / CRITICAL RESPONSIBILITIES:

1. Prepare appointment and reappointment applications for Department Chairperson, Credentials Committee, Medical Executive Committee and Board of Directors committee reviews. Attend committee meetings as assigned.

2. Oversees database management of demographic information on practitioners and tracking/updating of expired and incomplete information to ensure accurate and current data exist for each practitioner maintained in the database including content on current status of license registrations, board certifications, and other types of certifications that are time limited. Follow-up with applicable practitioners to update documents. Maintain database on practitioners on all expirables and other mandated primary source verifications.

3. Acts as staff to and manages the activities of the Ancillary Credentials Committee.

4. Act as liaison to hospital departments to ensure optimum third party plan participation of newly credentialed providers, if appropriate.

5. Assist in all aspects of operations to ensure department compliance with regulatory standards including, but not limited to the Joint Commission, NCQA, DOH, CMS, etc.

6. Prepare provider files in response to requests from government and regulatory agencies

7. Prepare practitioner files for government and regulatory agency credentialing audits. Participate in audits as required.

8. Participate in performance improvement projects designed to improve the efficiency and effectiveness of department operations.

9. Oversight and monitoring of FPPE/OPPE process for the medical staff and allied health professionals during the provisional appointment period and ongoing data collection for provider competency evaluations in compliance with regulatory requirements for reappointment.

10. Act as interface between credentialing/privileging and peer review processes.

11. Assist department director in policy and procedure development relating to

      credentialing and privileging.

2. Perform special projects as assigned.

3. Maintain accuracy and current status of privilege forms to SHS Shortcuts.

4. Maintain provider dictionary in Meditech.

5. Support practitioner orientation and onboarding as assigned.

6. Provides staff support to medical staff committees as assigned.

7. Maintain Credentials/Quality files in order to preserve an organized credentialing filing system.

8. Participates in performance improvement by conducting internal audits of the Credentials/Quality files and data analysis.

9. Assists with preparation for the Quarterly Medical Staff Meeting and Holiday party.

10. Performs other related duties as assigned or requested to maintain a high level of service.

11. Completes required continuous training and education, including department specific requirements.

Demonstrates professional work behavior by following Service Standards and Success factors.  Complies with departmental organizational policies and procedures and adheres to external agency requirements

Required Skills

• Excellent interpersonal skills, writing skills, ability to manage several tasks simultaneously.
• Computer literacy, working knowledge of word processing and spreadsheet applications.
• Individual must exhibit a high degree of responsibility for confidential matters. Must be able to work independently.  
• Knowledge of Joint Commission and State requirements and related record keeping preferred.
• Ability to function in a demanding environment, navigating multiple projects simultaneously, and effectively supporting a busy medical staff office.
• Some overtime possible if needed.

Required Experience

• Associate degree preferred or equivalency in work experience with related skills. NAMSS certification as a CPCS or CPMS is a plus. Must have skills needed to be proficient in the utilization of credentialing and privileging software.
• Minimum of three (3) years work experience, preferably in credentialing or medical staff office operations or in other health care setting

• Excellent interpersonal skills, writing skills, ability to manage several tasks simultaneously.
• Computer literacy, working knowledge of word processing and spreadsheet applications.
• Individual must exhibit a high degree of responsibility for confidential matters. Must be able to work independently.  
• Knowledge of Joint Commission and State requirements and related record keeping preferred.
• Ability to function in a demanding environment, navigating multiple projects simultaneously, and effectively supporting a busy medical staff office.
• Some overtime possible if needed.