Job Details

Medical Staff Coordinator - Credentialing

Company name

Organization Type

Public Interest

Job Type

Legal Staff

Date Last Verified

Sep 17, 2021

Valid Through

Dec 31, 2021

Posted on

Apr 08, 2021

Years of Experience

Min 2 yrs required

Location

South Weymouth, MA, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Health Care >> Health Care
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Medical Staff Coordinator - Credentialing
The candidate's duties include: Routinely handles highly sensitive and confidential information. Consistently maintains confidentiality of department information as observed by Manager. Initiates credentialing processes and procedures in accordance with the timeframes established within the Bylaws, organization credentialing plan, and within a sufficient timeframe to ensure best-evidenced based practice in credentialing and compliance with TJC requirements. Coordinates and maintains all processing of all aspects of physician and advanced practice practitioners credentialing processes within appropriate timeframes ensuring the quality of the practitioners providing patient care. Assures the completeness and accurateness of the credentialing process in accordance with TJC, CMS and State requirements and best evidenced based practice. Requests additional information from external and internal sources as needed. Collects and compiles data for provider profiles to analyze practice patterns using data to determine performance. This includes working with senior staff, determent chairpersons, quality staff, and other hospital staff to identify sources of data and methods of presenting and analyzing data. Is responsible and accountable for the primary source verifications of all aspects of credentialing and privileging in accordance with TJC, State and Federal regulations, organization policies, procedures, and Bylaws and best-evidenced based practice. Understands and maintains an accurate, secure and updated database of provider information to query on basic demographic profiles including but not limited to staff privileges and status for other hospital departments and facilities requiring this information. Uses various internal databased to gather and analyze provider data used in the reappointment, peer review, and quality improvement processes of the Medical Staff and Board of Directors.Obtains necessary privileging documentation and clinical activity for establishment and maintenance of competency requirements as defined by Joint Commission standards and State & Federal regulations. Ability to recognize and question responses to queries and competency requests as recommended by best-evidenced based practice and outlined by the Medical Staff Bylaws/Credentialing Policies and Procedures. Provides for timely and accurate collection, transmission, analysis and reporting of Center for Medicare / Medicaid Services and The Joint Commission, NPDB, and peer review statutes. Abstracts clinical data from patient encounters for privileging, OPPE, and FPPE following the rules in the specification manuals for Hospital Quality measures, HIPAA, and peer review statutes. Understands, is accountable for, and processes focused professional performance evaluations (FPPE) for providers for initial, reappointment, and new and additional privilege requests in accordance with TJC and Federal guidelines and regulations. Understands, is accountable for, and processes on-going professional performance evaluations (OPPE) for providers as required throughout a provider’s membership in accordance with TJC and Federal guidelines and regulations. Prepares credentialing and privileging, OPPE, and FPPE for review by Credentials Committee, Medical Executive Committee, Chairpersons, Administration according to Medical Staff Services standard to ensure appropriate approval of privileges and staff membership. Plays a key role in the organization’s patient safety initiatives, including practitioner education, development and identification of variations in care. Works collaboratively with Director, Manager, and key department and individuals in developing strategies and initiatives to improve compliance with medical Staff goals, objectives, and initiatives. Assists with focus studies, when appropriate, to support Medical Staff quality initiatives and Medical Staff performance improvement activities. Responsible for ensuring appropriate improvement follow-up occurs and effective collaboration with appropriate owner when needed. Process Medical Staff Resignations as needed. Process change of status requests as needed.

Qualification and Experience

The candidate ‘should have 2 years college education is preferred. National Certification as a Medical Staff Services Professional is preferred. Associate's degree in business or equivalent preferred. Must possess strong knowledge of medical staff office administration as normally obtained through three (3) years experience in healthcare, paralegal, managed care or credentialing. Requires knowledge of medical terminology and professional executive interface. Must possess strong professional verbal and written communication skills. Requires astute judgement in human relations skills to interface and communicate in an articulate manner with Medical Staff, administrators, legal counsel and hospital personnel. Requires proficiency in MS Office and credentialing software and ability to work with common office software and personnel.

Additional info

Req. Number: R-3978

Company info

Hiring Coordinator
South Shore Health
55 Fogg Road
South Weymouth, MA 02190

   

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