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System Credentialing Specialist

Traverse City, MI

Website:
https://nlx.jobsyn.org/ab2f3059e3ba461199414c448936f68f151

Posted on August 5, 2018

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About System Credentialing Specialist

ENTRY REQUIREMENTS

  • Bachelor’s degree in health related field required or equivalent experience.

  • Two years’ experience in medical staff/physician services, hospital credentialing, payer enrollment, or related field preferred.

  • Certification or eligibility/willingness to certify as a Certified Professional Credentialing Specialist (CPCS) within 3 years of hire.

  • Demonstrated working knowledge of Joint Commission standards, Medicare Conditions of Participation and other regulatory requirements with regard to compliance and credentialing.

  • Proficiency with electronic information systems, data management, and research/verification/payer/credentialing processes.

  • Interpersonal skills to interact effectively with various levels of hospital/practice management staff. Ability to communicate and process highly confidential information and to exercise proper judgment and discretion in performing duties.

  • Strong written and verbal communication skills.

ORGANIZATION

  • This position reports to the Manager of System Credentialing.

  • Works closely with local Medical Staff Offices and physician leaders at local facilities and/or System Chief Medical Officer.

  • Position is based out of the System Corporate Office.

AGE OF PATIENTS SERVED

No clinical contact with patients.

SPECIFIC DUTIES

  • Supports the Mission, Vision, and Values of Munson Healthcare.

  • Embraces and supports True North philosophy of Munson Healthcare.

  • Adheres to ESP House Rules and promotes personal and patient safety at all times.

  • Ability to exercise independent judgment within scope of knowledge and responsibility.

  • Serves as the central contact for all medical staff applications for incoming MHC providers for staff privileges or reappointment, as outlined in the Central Credentials Verification Policies and Procedures, closely monitoring information collection, cognitive analysis of all information received. Evaluates adequacy and quality of information.

  • Responsible for processing provider application, running primary source verifications, completing background checks, and other database queries as appropriate.

  • Using good judgement, must possess strong working knowledge of regulatory requirements (JCAHO, NCQA and AAAHC, and Medicare Conditions of Participation) to assess thoroughness of application for processing and completion.

  • Prepares files for local facilities, ensuring up to date and thorough information prior to file transfer.

  • Works with recruitment, payer enrollment, local medical staff contacts, as well as ambulatory practice staff and leadership to ensure accurate, complete and timely file completion.

  • Communicate within internal departments and external sources with significant attention to detail, consistency, accuracy and preciseness.

  • Responsible for verifying all information garnered through investigation and follow up processes, maintaining HIPAA and regulatory compliance, while adhering to Joint Commission standards, CMS guidelines, and other regulatory bodies at all times.

  • Understands Medical Staffs, governing bodies, and bylaws of local facilities.

  • Ensures integrity of all databases and department systems by recording consistent and accurate information and facilitates sharing data with key stakeholders throughout the organization. Exhibits a thorough understanding of government and department guidelines, policies and procedures.

  • Supports healthcare team by supporting all physician services functions including recruitment, credentialing, payer enrollment, onboarding, data integrity, physician liaison, and provider relations/education.

  • Performs other duties and responsibilities as assigned.

Job at a Glance

About Munson Medical Center

How to Apply