Credentialing Coordinator - Temporary

Department Overview

This is a 3 to 5 months Temporary role 

 

OHSU is Oregon’s only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health – and with a network of campuses and partners throughout Oregon. We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland’s largest employer. And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.

 

The Medical Affairs Program facilitates credentialing and privileging for OHSU clinical practitioners including our partners OHSU Health Adventist Health Portland and Hillsboro Medical Center. We work closely with Provider Enrollment to ensure that OHSU clinical staff maintain credentials, privileging and active billing status.

Function/Duties of Position

• Processes applications for credentialing and privileging for both initial appointments and reappointments and/or privileging, as defined by established policies and procedures. This process requires detailed knowledge of legal, state, OHSU, DNV, TJC, and NCQA guidelines in assuring compliance with regulatory standards. Recognizes, investigates and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources. Regular communication with credentialing contacts is central to ensuring timely and accurate completion of the credentialing process. Credentialing and privileging are conducted for multiple partner hospitals.
• Organization and maintenance of practitioner credential files, which contain confidential peer review information. As applicable when processing practitioner applications, this position involves consistent and professional follow-up for outstanding applications, conducting primary source verification, obtaining clinical activity documentation, and other searches such as OIG, Opt-Out and NPDB for presentation to the Credentials Committee and Professional Board/Medical Executive Committee/Governing Board. Staff member tracks status of responses, follows up on missing information, and obtains appropriate approvals to assure that the practitioners’ credentials and quality files are complete, accurate, and up-to-date.
• May need to collaborate with physician leaders and the Medical Affairs Director to develop and maintain a facility-specific, criteria-based clinical privileging system in accordance with regulatory requirements, accreditation standards, and organizational policies.
• Work with Medical Affairs Director on development of Focused and Ongoing Performance Data monitoring evaluation and criteria based on privileges at OHSU and Hillsboro Medical Center. This position is responsible for tracking FPPE and OPPE from a variety of departments.
• Maintenance of confidential computerized information on MSOW credentialing database for all applications for appointments and reappointments, as well as any other processing such as additional privileges, temporary privileges, status changes and more. Detailed documentation during all steps in the credentialing process and updating and/or revising information in the database regarding credentialing on a daily basis from receipt of application to completion of processing is key.
• May be required to perform and coordinate meeting logistics, documentation preparation, and follow-up at OHSU and Hillsboro Medical Center.
• Responds to requests for verifications from external organizations.
• Participates in work process audits and supports special department projects and other duties as assigned. Analyzes credentialing and privileging data for special reports and projects; conducts special studies as requested.

Required Qualifications

• High School Diploma or GED required AND 3 years medical staff credentialing experience in a healthcare or insurance provider setting; OR 
• Associates Degree and 3 years experience performing data collection or data analysis using complex database software systems; OR 
• A combination of education and experience.

Job Related Knowledge, Skills and Abilities (Competencies):

• Demonstrated software database experience (for efficient generation of letters and other correspondence, activity tracking and report production).
• Familiarity with legal, state, TJC and NCQA guidelines in assuring medical staff compliance with regulatory agencies.
• Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flo