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Posted: 20-Sep-24
Location: Rockwall, Texas
Salary: Open
Internal Number: 24014850
JOB SUMMARY
Hybrid Position
Accountable for the computerized operations of the centralized credentials verification system by managing all components of the medical staff database, including data entry, creating reports, and maintaining software. Serves as team member in coordinating medical staff and allied health professional initial appointments and reappointments. Tracks the flow of credentialing information throughout the Scott & White System and to delegating credentialing entities.
Under general supervision, accountable and accountable for all functions relating to the administrative work in coordinating credentialing and re-credentialing and the clinical privileging of the medical staff and delineation of services for the allied health professionals and others as appropriate for the Baylor Scott & White Health. Accountable for the accuracy and integrity of the credentialing and clinical privileging database system. 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
- Processes confidential medical staff and allied health professional files requests for, but not limited to new applications, reappointment applications, temporary applications, more privileges, staff category changes, resignations / retirement.
- Maintains data integrity of the credentialing and clinical privileging software system. According to established policies and procedures, accountable for the integrity of data
- Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet.
- Ensures maintenance of medical staff and allied health professional files.
- Ensures that results of medical staff quality management findings are provided to appropriate review committees/ departments and maintained in a confidential file.
- Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.
- Acts as a liaison between the medical staff, allied health professionals, nursing services and administration.
- Performs other duties as required. Job duties are subject to changes as directed by management.
- Accountable for recording and maintaining clinical privileges for physicians and allied health staff members in the database.
- Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff and allied health professionals in compliance with the medical staff bylaws, medical staff policies and procedures, AHP policies, JCAHO, CMS standards and other regulatory agencies.
- Oversee the system credentialing database
- Develops a standardized system of database entry/attributes and trains staff on standardized data entry to the system.
- Utilizes software functions to convert paper documents to electronic files where possible.
- Works with IS on web-based links to help on-line privilege queries and directories.
- Executes initial appointment and re-appointment application under departmental policy
- Receives applications and enters data and requested privileges into the credentialing database. Prepares application packets for distribution to applicants.
- Assigns applicants to appropriate facility(s) and communicate with appropriate facility representatives.
- Scans and emails completed credentials files to appropriate facility(s) in a timely way.
- Maintains records of all changes to practitioner status and demographics and communicates to appropriate departments.
- Plans and develops helping documentation (agendas, minutes, reports for Credentials Committee and others as assigned.
- Monitors time-limited documents to assure continuous currency
- Follows departmental expiring document policy to assure proper notification to practitioners of impending expirations.
- Accesses primary verification sources to document renewed licenses and certifications, enters renewals into database and files hard copy in credentials file.
- Notifies director of expiring documents.
- Design reports and queries to help the functions of the department
- Prepares scheduled and ad hoc reports for both internal and external customers according to established timelines and distribution lists.
- Maintains current knowledge of the joint commission and NCQA Standards
- Regularly participates in learning opportunities to keep current in the credentialing industry.
- Preferred: Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or education plan to obtain in eighteen (18) months from date of hire.
- Perform other position duties as required
KEY SUCCESS FACTORS
- Commitment to continuous learning and keeping abreast in the Medical Staff Services industry.
- Experience in database management, medical staff and/or credentialing services required.
- Exceptional organizational skills, independent work management skills, and proficiency in working with computerized databases required.
- Bachelor's degree preferred.
- CPCS certification by the National Association of Medical Staff Services preferred.
- Cactus experience preferred.
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 - 2 Years of Experience