Credentialing specialist Jobs in Tucson, AZ

This position is a hybrid role working 3 days in office and 2 days from home. Therefore, you do have to live within Pima County / Tucson area so that you are able to come into the office weekly.

Experience with hospital credentialing is required, payer credentialing preferred!

SUMMARY :

Performs and monitors all credentialing functions, including complex credentialing issues and brings forward issues to the Medical Staff Credentialing Lead and / or Director. Interfaces with senior medical staff leaders and administration and presents information when necessary. Utilizes knowledge of bylaws, rules, and regulations, expertise, sound judgment to mentor and support Medical Staff Credentialing Specialists I, other peers and leadership. Acts as a liaison between Administration and members of the Medical Staff.

ESSENTIAL FUNCTIONS :

Applies knowledge, expertise, sound judgment and consults other references and resources as necessary to generate and evaluate solutions and recommendations.

Applies knowledge of bylaws, rules, and regulations to effectively serve as a Medical Staff Representative, to ensure timely flow of work.

Ensures compliance with all applicable regulatory requirements. Supports oversite and participates in internal, external, accreditation and compliance surveys, reviews and audits as required

Takes all critical information into account, considering interrelationships among issues and implications for other stakeholders. Applies knowledge, expertise, sound judgment and other references and resources as necessary to generate and evaluate solutions and recommendations. Understands and appropriately applies principles, procedures, requirements, regulations, and policies.

Utilizes knowledge of bylaws, rules, and regulations, expertise, sound judgment to mentor and support Medical Staff Credentialing Specialists I, other peers and leadership.

Utilizes credentialing software for new and reappointment letters, resignations, leave of absences, changes in staff category, add / delete privileges.

Coordinates, monitors and maintains the credentialing and recredentialing process.

Reviews applications and other data for accuracy and completeness.

Performs primary source verification of initial and reappointments applications by preparing requests for information letters, tracking responses and follow-up for needed information.

Obtains licensure, insurance and other certificates at time of reappointment or as they expire and enters them in our database.

Enters accurate and up-to-date data for each applicant into the database and responds to verification requests.

Ensures the accuracy of documentation to support the request for privileges by maintaining good working relationships with clinical departments, Medical Staff leadership and professional agencies.

Assists in compliance with the accrediting and regulatory agencies in regards to credentialing.

Answers phones, makes copies, prepares mailings and maintains files.

Assists with timely maintenance and accuracy of database.

Effectively communicates with peers to ensure information regarding practitioners is current.

Composes correspondence including board letters as required.

Supports Medical Staff meetings; records meeting minutes and maintains an accurate record of decisions as required.

Maintains register of applications and expired certificates / licenses and assists with all mid-cycle updates.

Processes application fees and records deposits as required.

Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION : High school diploma or general education degree (GED) with extensive computer background. Preferably, associate's degree in computer science and / or health field with advanced computer courses.

EXPERIENCE : Four (4) years of medical staff credentialing experience in an acute care setting.

LICENSURE OR CERTIFICATION : None required. CPCS or CPMSM preferred.

KNOWLEDGE, SKILLS AND ABILITIES :

• Knowledge of healthcare practices and procedures.
• Skill in maintaining a detailed database, creating reports and maintaining files.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical and software related procedures and manuals, governmental regulations.
• Inspires trust and confidence among stakeholders through reliability, authenticity, and accountability.
• Expresses thoughts clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward and across the organization by actively listening and encouraging the open expression of ideas and opinions
• Establishes productive, cooperative relationships with subordinates, peers, management, and stakeholders both internal and external to the organization.
• Ability to effectively present information and respond to inquiries or complaints from eproviders.
• Ability to add, subtract, multiply, and divide using whole numbers, common fractions and decimals.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.