PAYOR CREDENTIALING - MED STAFF

Why Beebe?

Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.

Overview

Under the direction of the Manager of the MSSD, the Credentialing Specialist (CS) manages the functions required to support credentialing and privileging activities of the medical staff organization. Ensures that the credentialing and privileging activities of the medical staff organization meets all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation (The Joint Commission standards, state laws and Medicare Conditions of Participation). This includes, but is not limited to application management, primary source verification of credentials, file maintenance (electronic and / or hard copy), and maintenance of expiring information, information management and direct support of the evaluation and decision-making process.

Responsibilities

Works closely with the Manager of the MSSD, department chairs and the Credentials Committee to define and delineate appropriate privilege forms and to assist in developing and establishing criteria for the granting of privileges. Coordination of application management. Ensures a timely application process in Credentialing and Re-Credentialing per the Medical staff bylaws. Assures that data entry of required primary source verification data elements and practitioner credentials files are managed in accordance with procedures as outlined in the Medical Staff bylaws, medical staff Rules & Regulations and Medical staff policies. Preparation of practitioner information for review and evaluation by medical staff leaders and support of follow-up actions taken by the medical staff organization with regard to practitioner qualification and competency management. Red flagging potentially adverse information for the medical staff leadership review. Identify areas where practitioners may not meet privileging or membership criteria. The Specialist shall monitor expiring information such as : DEA, license, professional liability insurance, specialty board certification status, etc. and maintain and update credential files and the practitioner database. Support and work with the Medical Staff Quality Coordinator on other competency management functions such as proctoring, focused and ongoing performance evaluations, etc. in accordance with bylaws, rules and regulations and policies and procedures. Effectively communicate issues and ongoing status of assigned work to Manager of MSSD Develop and / or maintain mechanisms for tracking and updating various physician related information (i.e. Medical Record fines, Due, etc.) and communicate this with necessary medical staff personal. Initiate and run required computer programs necessary to obtain needed physician statistics and pertinent credentialing data. Be available to attend physician functions and arrange for appropriate office / phone coverage while away. Perform multiple duties and assignments within the same time frame, meeting a designated deadline. The CS may be responsible for meeting management for one or more medial staff departments or committees. This may include scheduling, agenda planning, in-meeting support, post meeting documentation and follow-up items. Assure that all documentation reflects that required activities are undertaken by individuals and meeting members and that relevant information is communicated to the MEC, board of directors, or others as necessary. Maintain all medical staff committee and department meeting minutes for archiving and regulatory compliance. Facilitate communications between medical staff organization and administration in matters that require cooperation. In conjunction with the Manager of the MSSD, assist in the maintenance and protection of the confidential medial staff credential files and quality files. In conjunction with the Manager of the MSSD, assist in the maintenance, review and creation of medical staff office policies and procedures.

Qualifications

Two years credentialing and privileging experience recommended. Familiarity with medical and legal terminology desired. Ability to work with Microsoft products, credentialing software, and learn new database programs. Excellent interpersonal communication skills necessary. Ability to work in a highly confidential environment. Strong computer skills necessary. Knowledge of other business subjects desirable.

Once meeting the eligibility requirements to take the exam, certification is strongly encouraged but not required .

Competencies Skills

Essential :

• Clear Communication Skills Both Written and Verbal
• Knowledge Of Basic Computer Programs
• Able To Keep Confidential Information Regarding Patients, Team Members
• Able To Withstand Crisis Situations
• Has Skills to Provides Customer Service to Patients, Team Members and Visitors
• Experience With Excel, Power Point, Word, Visio, Etc.

Credentials

Education

Essential :

Entry

USD $24.14 / Hr.

Max

USD $37.42 / Hr.