Nashville, Tennessee
Spartanburg, South Carolina
Posted: 12-Jul-24
Location: Denton, Texas
Salary: Open
Categories:
Internal Number: 24010559
JOB SUMMARY
Under general supervision, accountable for all functions relating to coordinating, supervising, auditing and monitoring of the approval process for credentialing and re-credentialing and the clinical privileging of the medical staff and delineation of services for all the facilities Medical Staff Services Department. This is accomplished through partnership and coordination with medical staff managers and administrative representatives. Functions as a member of the team to assure optimum performance of the department. Provides information and guidance about medical staff bylaws, medical staff rules and regulations, allied health professionals (AHP) policies, Joint Commission for Accreditation of Healthcare Organizations (JCAHO) and Center for Medicare and Medicaid Services (CMS) and other regulatory agencies as they pertain to medical staff and allied health professionals
ESSENTIAL FUNCTIONS OF THE ROLE
- Audits and evaluates processes involved in verifications for medical staff and advanced practice professionals appointments, reappointments and privileges delineations.
- Audits applications, review helping documents including all primary source verification for credentialing and re-credentialing to ensure medical staff and advance practice professional files are current and policies and procedures have been followed to obtain required documentation and verification.
- Coordinates the processing of applications through the hospital review process and committee meeting structure and assures all applications are processed completely and in a timely manner.
- Accountable for auditing files that are asked to be reviewed during regulatory surveys (TJC, CMS, Etc.) and presenting such files to the surveyor (duties of facility team lead).
- Accountable for preparing final Credentials Report for Governing Board (Board) and for preparing change memo notification to general staff after Board meeting (duties of facility team lead).
- Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, advance practice professional policies, as well as other policies and procedures pertaining to credentialing, etc.
- Works with manager and/or director for assuring that the findings, conclusions and recommendations for actions to appointment or reappointment applications and/or improve the credentialing program are reported through appropriate medical staff committees, or appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.
- Accountable for contacting Credentials Committee Members about monthly review of credentials files and serve as resource to the reviewers for any questions that may arise.
- Coordinates the processing of applications through the hospital review process and committee meeting structure.
- Attends meetings and helps with the preparation of agendas, research and committee packets (duties of facility team lead).
- Works with manager and/or director and makes recommendations for credentialing and privileging forms as needed.
- Oversees ongoing development and revisions of delineation of privileges utilizing heavy physician input and physician committee approval. (Duties of facility team lead)
- Participates in system integration and continuing quality improvement efforts.
- Assures appropriate implementation of new credentialing software and ongoing development efforts as I related to regulatory agency requirements for credentialing.
- Accountable for the primary interface with Credentials Committee Chairmen, and other key medical staff managers around medical staff issues.
- Serves as information resource in credentialing to medical staff and advance practice professionals.
- Provides administrative and technical help to medical staff department and committee meetings.
- Works with manager and/or director for follow up action as required including composition of correspondence for chief/chairperson as well as distribution of materials. (Duties of facility team lead).
- Performs other position appropriate duties as required in a competent, professional and courteous manner.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based on position type and/or level
QUALIFICATIONS
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 3 Years of Experience
CERTIFICATION/LICENSE/REGISTRATION -
- Cert Medical Staff Coord (CMSC), Cert Provider Credentling Spec (CPCS), Cert Prof Medical Services Mgr (CPMSM): Must obtain one of the following within 24 months of hire:
- Certified Medical Staff Coord (CMCS) or
- Certified Provider Credentialing Spec (CPCS) or
- Certified Prof Medical Services Manager (CPMSM).