Processes medical and allied health staff applications for appointment, clinical privileges and provider enrollment and assists medical staff leaders in analyzing and evaluating the information provided.
Develops and maintains Management Information Systems related to medical and allied health staff for hospital wide use. Includes tracking mechanisms for all expiable documents; i.e., licenses, insurance policies, etc., as well as board certification documents.
Processes medical and allied health staff applications and reapplications for appointment and clinical privileges as well as provider enrollment for insurance plans. Conducts primary source verification. Assists medical staff leaders in analyzing and evaluating the information provided.
Participates in at least 4 medical staff meetings throughout the year including but not limited to meeting set up, preparing Agendas, inviting committee members, meeting reminders, room set up and taking minutes.
Maintains close communication with the Insurance Plans, IRMA Director, medical staff leadership, Director, Medical Staff Services, Human Resources and other department members related to activities of hospital and medical staff departments/committees to provide implementation, compliance and/or follow up on issues related to the medical and allied health staff. Follows up with supervisor regarding any unresolved problems.
Assists with delegated credentialing audits and/or department audits, TJC tracer reviews.
Develops and maintains hospital information systems related to medical and allied health staff for hospital wide use.
Includes tracking mechanisms for all expireable documents, i.e., licenses, insurance policies, etc. as well as board certification requirements.
Willingness to learn the Intranet processes for the Policy and Procedures, Call Schedules, and assist with maintenance of such.
Coordinates Emergency Department on call process including schedule development, maintenance, communication and compensation.
Possesses a working knowledge of medical staff and hospital bylaws, policies, rules and regulations, Joint Commission standards and state and federal statutes. Responds to inquiries.
Willingness to learn Managed Care processes including but not limited to the various insurance company procedures, CAQH enrollment processes, PECOS enrollment processes.
5 years Hospital Credentialing Experience
Managed Care experience preferred
CPCS or CPMSM
Additional Salary Information: Depends upon years of experience