JOB SUMMARY

Under general supervision, responsible for all functions relating to coordinating, assigning, auditing, monitoring and key reporting of the credentialing and clinical privileging process of the medical staff and delineation of services for the allied health professionals on behalf of the CVS. This is accomplished through collaboration and coordination with all Baylor Scott & White Health Medical Staff Services Directors and Coordinators and practitioner offices. In addition, works in conjunction with the CVS Director to establish process improvement and assists in driving department initiatives. 

Functions as a member of the team to assure optimum performance of the department. Provides information and guidance regarding 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.  Functions as a member of the team to assure optimum performance of the department.

ESSENTIAL FUNCTIONS OF THE ROLE

Assigns and coordinates distribution of files to coordinators.

Works with team to develop and meet production goals.

Evaluates processes involved in verifications for medical staff and allied health professionals appointment, reappointment and privilege delineation.

Ensures compliance with medical staff bylaws, rules and regulations, allied health professionals policies, other policies and procedures and appropriate regulatory agencies such as the Texas Department of Health (TDH) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Provides statistical information to facilitate initial and reappointment productivity to Senior Leadership.

Audits applications, review supporting documents including all primary source verification for all credentialing and re-credentialing to ensure medical staff and allied health professional files are current and policies and procedures have been followed to obtain required documentation and verification during 90 day probationary period. Performs monthly random audits thereafter.

Acts as a liaison between all Baylor Scott and White Healthcare facilities and the CVS as well as practitioner offices.

Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the Medical Staff Services Department by belonging to professional organizations, attending seminars, and reading journals and publications addressing medical staff activities.

Works files as necessary to support the credentialing process.

Provides input on team performance in conjunction with evaluations.

Coordinates activities for and may participate in The Joint Commission or internal mock surveys as requested.

Participates in system integration and continuing quality improvement efforts.

Provides appropriate feedback on implementation of new credentialing software and ongoing development efforts as it relates to regulatory agency requirements for credentialing.

Assists the CVS Director in the ongoing development and implementation of policies and procedures that guide and support the provision of services.

KEY SUCCESS FACTORS

Requires Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or education plan to obtain in twelve (12) months of hire.

Requires three years of experience in hospital and/or health care credentialing.

Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and Joint Commission on Accreditation of Healthcare Organizations standards.

Knowledge of Health Line System (Medical Staff Line and/or Echo) or other credentialing system preferred.

Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services preferred.

Advanced computer skills in word processing, spread sheets and databases preferred.

Ability to function efficiently under stress due to demands related to deadlines and medical staff issues.

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 upon position type and/or level

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - 3 Years of Experience
• CERTIFICATION/LICENSE/REGISTRATION - Cert Provider Credentling Spec (CPCS), Cert Prof Medical Services Mgr (CPMSM): Must have either Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM).
   

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