Medical Staff Specialist - Credentialing

JOB SUMMARY

The Medical Staff Specialist will work in conjunction with the Medical Staff Coordinator and Director of Medical Staff Services to process credentialing and re-credentialing applications of health care providers, reviews applications, prepares verification letters and maintains database.  Reviews applications and other data for accuracy and completeness.  Performs verifications of reappointment applications by preparing requests for information correspondence, tracks responses and follow-ups for needed information.  Obtains licensure, certification and insurance certificates at time of reappointment and maintains in database.  Enters accurate and up-to-date data for each applicant into the database and response to verification requests.  Works under the supervision of the Medical Staff Coordinator.  Assist in compliance with The Joint Commission and CMS in regards to credentialing while developing and maintaining a working knowledge of the statutes and laws. 

Interacts with external customers such as regional and corporate colleagues with credentialing responsibilities, licensing officials and regulatory bodies. The incumbent may have access to highly confidential patient, employee and/or proprietary information, and must handle and protect the information in accordance with hospital and system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position, and conducts all job responsibilities according to the Mission and Values of T.J. Regional Health.

JOB REQUIREMENTS

Minimum Education

§  Must possess a high school diploma or equivalent.

§  Some college or business college from an accredited curriculum desirable.

Work Experience

§  Related work experience in healthcare is preferred

§  Business administrative experience acceptable

Required Skills

§  Ability to work independently

 

§  Proficiency with Microsoft Office applications

 

§  Ability to prioritize work independently

 

§  Strong organizational skills

 

§  Ability to communicate professionally and with various communication styles

 

§  High level of follow through with multiple project requirements

 

§  The highest level of confidentiality with both documentation and with day to day communication

FUNCTIONAL DEMANDS

Physical Requirements

Sitting - 16-31%

Walking – Greater than 32%

Standing - Greater than 32%

Bending/Squatting - 16-31%

Climbing/Kneeling - 16-31%

Twisting - 16-31%

OSHA Category

Minimal potential for direct body fluid exposure

Visual and Hearing Requirements

Must be able to hear clearly with assistance.

Must be able to see with corrective eyewear.

Color vision ability required.

Other Physical/Environmental Demands

Lifting - 0-50lbs, 50lbs or more with assistance

Carrying - 0-50lbs, 50lbs or more with assistance

Pulling - up to 100lbs 

Pushing - up to 100lbs

LEADERSHIP CAPABILITIES

Supports the hospital Mission, Service and Values.

ESSENTIAL FUNCTIONS

§  Process and execute developed plan for each applicant.

 

§  Accurate and current data entry.

 

§  Analyze conducted verifications from primary sources and prepare any “red flags” for reporting.

 

§  Prepare submission for review by Medical Staff Coordinator and/or Director of MSS.

 

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