SGMC Health
CREDENTIALING COORDINATOR, MEDICAL STAFF SERVICES
SGMC Health, Valdosta, Georgia, United States, 31601
CREDENTIALING COORDINATOR, MEDICAL STAFF SERVICES
Location: Main Campus
Responsibilities
Plans, organizes, and maintains centralized, comprehensive credentialing for the Medical Staff that includes pre-applications, initial appointment, annual review, reappointment, proctoring, and privileging in accordance with regulatory, accrediting agency and bylaws requirements, assuring accuracy, and providing reports as required/requested.
In the process of credentialing and re-credentialing, run background checks, DEA checks, license checks, reference checks, and make determinations to ensure valid and current status.
Determine if results of background checks, education, licensing, health related requirements and national data bank results meet qualifications to proceed further in the application process.
Recognize, investigate and validate discrepancies and adverse information obtained from the application, primary source verifications, or other sources; make a decision around discrepancies and present to the Director of Medical Staff Services.
Work closely with the CMO, Chief of Staff, Department Chairmen, Section Chiefs, PQC, AHP/LLP and Medical Staff Director in the review/recommendation process, including recommendations adverse to the applicant.
Confirm that current knowledge, as well as the following are current, reflect current practice and are consistent with and in compliance with all standards and regulations: Medical Staff By-Laws, Threshold Criteria, Rules, Regulations, and Joint Commission.
Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, databases) by analyzing the needs and resources of medical services/credentialing.
Collaborate with Hospital entities, schools, etc., for affiliations and employment verifications.
Respond to queries from outside organizations and from within regarding physician credentials for all contracted Providers.
Obtain signatures from departmental section and chiefs when credentialing process is complete.
Perform and coordinate provider relinquishments with system administrators.
Verify supervising physicians for all Allied Health Professionals with the Composite Medical Board.
Respond and assist the quality department review of FPPE/OPPE and other items as needed.
Perform delegated credentialing for providers outside of the hospital, such as Urgent Care/Youth Care.
Visit physicians’ offices when necessary to obtain signatures.
Assist Chief Medical Officer, Compliance Department and Medical Staff Director with preparing reports, special projects, and correspondence when needed.
Knowledge, Skills & Abilities
Undergraduate degree from regionally accredited academic institution in business or healthcare related field and three to five years experience in Medical Staff Services or a combination of education and/or experience preferred.
Ability to review, research and make sound decisions with the results found during the discovery process of Medical Staff candidates.
Ability to communicate in a professional manner while bringing forth findings, discrepancies, and/or concerns with candidates’ files in regards to credentialing with the Director of Medical Staff Services, Chief Medical Officer, Chief of Staff and Department Chiefs.
Medical terminology knowledge preferred and proficient computer skills required such as Microsoft Word, Excel and Outlook.
CPMSM or CPCS Certification obtained after three years of assuming role of Credentialing Coordinator.
Considerable mental effort, ability to draft and prepare minutes, correspondence and reports.
Ability to work independently and prioritize projects.
Impeccable integrity and ethics.
Excellent critical thinking skills and communications both oral and written.
Exceptional organizational skills with attention to detail and accuracy.
Research bylaws and legal guidelines.
Ability to de-escalate grievances of visitors and physicians and use sound judgment when dealing with stressful situations.
Competency in accelerated PC use and required tools.
Working Conditions Office setting. Safe working environment, possibility of irregular work hours upon request. Perhaps some discomfort due to noise and crowded conditions. A moderate amount of stress at times. Involves sitting, standing, and bending.
See What All Of The Hype Is About https://www.youtube.com/watch?v=_DeqKw8xk54
#J-18808-Ljbffr
Responsibilities
Plans, organizes, and maintains centralized, comprehensive credentialing for the Medical Staff that includes pre-applications, initial appointment, annual review, reappointment, proctoring, and privileging in accordance with regulatory, accrediting agency and bylaws requirements, assuring accuracy, and providing reports as required/requested.
In the process of credentialing and re-credentialing, run background checks, DEA checks, license checks, reference checks, and make determinations to ensure valid and current status.
Determine if results of background checks, education, licensing, health related requirements and national data bank results meet qualifications to proceed further in the application process.
Recognize, investigate and validate discrepancies and adverse information obtained from the application, primary source verifications, or other sources; make a decision around discrepancies and present to the Director of Medical Staff Services.
Work closely with the CMO, Chief of Staff, Department Chairmen, Section Chiefs, PQC, AHP/LLP and Medical Staff Director in the review/recommendation process, including recommendations adverse to the applicant.
Confirm that current knowledge, as well as the following are current, reflect current practice and are consistent with and in compliance with all standards and regulations: Medical Staff By-Laws, Threshold Criteria, Rules, Regulations, and Joint Commission.
Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, databases) by analyzing the needs and resources of medical services/credentialing.
Collaborate with Hospital entities, schools, etc., for affiliations and employment verifications.
Respond to queries from outside organizations and from within regarding physician credentials for all contracted Providers.
Obtain signatures from departmental section and chiefs when credentialing process is complete.
Perform and coordinate provider relinquishments with system administrators.
Verify supervising physicians for all Allied Health Professionals with the Composite Medical Board.
Respond and assist the quality department review of FPPE/OPPE and other items as needed.
Perform delegated credentialing for providers outside of the hospital, such as Urgent Care/Youth Care.
Visit physicians’ offices when necessary to obtain signatures.
Assist Chief Medical Officer, Compliance Department and Medical Staff Director with preparing reports, special projects, and correspondence when needed.
Knowledge, Skills & Abilities
Undergraduate degree from regionally accredited academic institution in business or healthcare related field and three to five years experience in Medical Staff Services or a combination of education and/or experience preferred.
Ability to review, research and make sound decisions with the results found during the discovery process of Medical Staff candidates.
Ability to communicate in a professional manner while bringing forth findings, discrepancies, and/or concerns with candidates’ files in regards to credentialing with the Director of Medical Staff Services, Chief Medical Officer, Chief of Staff and Department Chiefs.
Medical terminology knowledge preferred and proficient computer skills required such as Microsoft Word, Excel and Outlook.
CPMSM or CPCS Certification obtained after three years of assuming role of Credentialing Coordinator.
Considerable mental effort, ability to draft and prepare minutes, correspondence and reports.
Ability to work independently and prioritize projects.
Impeccable integrity and ethics.
Excellent critical thinking skills and communications both oral and written.
Exceptional organizational skills with attention to detail and accuracy.
Research bylaws and legal guidelines.
Ability to de-escalate grievances of visitors and physicians and use sound judgment when dealing with stressful situations.
Competency in accelerated PC use and required tools.
Working Conditions Office setting. Safe working environment, possibility of irregular work hours upon request. Perhaps some discomfort due to noise and crowded conditions. A moderate amount of stress at times. Involves sitting, standing, and bending.
See What All Of The Hype Is About https://www.youtube.com/watch?v=_DeqKw8xk54
#J-18808-Ljbffr