Medical Staff Credentialing Specialist

POSITION SUMMARY
Responsible for assuring that the credentialing and privileging of practitioners is conducted in accordance with approved credentialing policies & procedures, Medical Staff Bylaws and Rules & Regulations of ASC.

ESSENTIAL FUNCTIONS
1. Coordinates, with the Supervisor, management of medical staff committees including compiling agenda material, accurately documenting minutes following regulatory requirements, generating follow-up correspondence, researching and preparing information for medical staff leadership, and strictly protecting credentialing and peer review confidentiality. Provides consultation regarding privileging, credentialing, reappointment, and corrective action processes as defined in the medical staff bylaws and applicable policies and procedures. Coordinates communication of information among medical staff departments, clinical service areas and administration.

2. Provides professional assistance and serves as a resource for medical staff members regarding medical staff bylaws, rules and regulations, hospital and medical staff policies, state statutes, licensing boards regulations, and other regulatory and accreditation agency standards and parliamentary procedure. Assists in the coordination of physician training and educational programs sponsored by medical staff services. Provides orientation to new medical staff leaders.

3. In consultation with supervisor, may communicate sensitive and confidential issues with medical staff leaders and/or senior administration, including peer review and professional conduct involving physicians and allied health professionals. May interact directly with internal and medical staff legal counsel. Uses judgment and discretion to maintain peer review protection of hospital and medical staff.

4. Maintains an accurate, secure, and current database of physician and allied health provider information. Uses various internal resources and databases to gather and analyze physician and allied health credentialing and performance data used in the reappointment, peer review, and performance improvement processes of the medical staff.

5. Maintains quality controls on all aspects of physician and allied health credentialing and reappointment processes and assures the credentialing activities are completed within appropriate timeframes. Exercises judgment and discretion in recognizing legal implications of credentialing functions and medical staff issues. Drafts appropriate correspondence utilizing knowledge of state statutes and legal guidelines in requesting additional information from external medical and legal sources if necessary. Assists with appropriate credentialing procedures, forms and time limits. Maintains an effective process for maintaining current information for expirable credentials, e.g. license, DEA, insurance. Assists in orienting new medical staff members to ASC protocols and services.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

SCOPE AND COMPLEXITY
Requires the constant exercise of a high degree of independent judgment and initiative in response to complex, sensitive issues, decision making, and discretion. Requires limited direction and guidance. Addresses moderately difficult problems. Maintains professional relationships with members of the administrative staff of the hospital, members of the medical and affiliated staff, medical staff officers, medical staff department chairs, section chiefs, physician and other professional applicants, attorneys, medical staff professionals at other facilities, state licensing bodies, other departmental personnel and customers. All require courtesy, tact, patience, collaboration, and confidentiality.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS
OE – Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager)

• Requires extensive sitting with periodic standing and walking.
• May be required to lift up to 20 pounds.
• Requires significant use of personal computer, phone and general office equipment.
• Needs adequate visual acuity, ability to grasp and handle objects.
• Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.
• May require off-site travel

MINIMUM QUALIFICATIONS

Must possess strong interpersonal skills and general knowledge of healthcare administration, and regulatory compliance.

Requires Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) or comparable experience and knowledge in medical staff services. 3 -5 years of experience in medical staff services or comparable work experience is required.

Must possess extensive knowledge of medical staff operations, policies, rules and regulations, regulatory agency guidelines and standards. Must possess demonstrated leadership abilities. Requires experience interacting with physicians in highly sensitive situations. Must possess strong verbal and written communication skills. Requires astute judgment in human relations skills to interface and communicate in an articulate manner with medical staff, administrators, legal counsel and hospital personnel. Requires the ability to work with common office software and equipment.

PREFERRED QUALIFICATIONS
Knowledge of medical staff computer software programs is desirable.

Additional related education and/or experience preferred.

We are an equal opportunity employer and make hiring decisions based on merit. Recruitment, hiring, training, and job assignments are made without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, or any other protected classification. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.