Job description
GENERAL SUMMARY: Under general supervision, this position supports the integrity and effectiveness of the credentialing and privileging in compliance with Medical Staff Bylaws, Rules and Regulations, and all federal, state and licensing agency requirements for initial appointment and reappointment for Beaumont Health and/or managed care.
Provides administrative support for the Credentials Committee. This position ensures that all credentialing records comply with regulatory and accrediting standards, are up-to-date and in continuous preparation for audits. Facilitates the review of applications by appropriate staff and committees.
Serves as a resource to the Medical Staff leadership, Medical Staff committees and medical staff regarding the investigation and recommendation decisions regarding individual credentials and qualifications of physicians and other practitioners/providers.
ESSENTIAL DUTIES:
- Organizes, schedules and performs credentialing research and workflow activities required for the credentials verification of initial appointment and reappointment of practitioners applying Beaumont Health Medical Staff; tracks applications and prepares appropriate documentation for the Medical Staff leadership and committee approvals.
- Reviews and analyzes physician applications and credentialing documents. Assesses completeness of information and provider’s qualifications relative to established standards. Identifies adverse information and conducts appropriate follow-up investigations.
- Maintains an accurate, up-to-date confidential credential file for each physician and advanced practice provider.
- Enters data from applications into the credentialing software database. Compiles data and generates a variety of statistics, letters, correspondence and other informational reports for review, verification and decision management.
- Prepares credentialing materials for Medical Staff leadership and Medical Staff committees to review for recommendations to the Medical Staff. Monitor recommendations from leadership. Coordinates and supports all Credentials and Qualifications Committee activities in collaboration with Medical Staff leadership and Medical Staff committees, including agenda preparation, recording of minutes and follow-up correspondence and reports for the Medical Executive Board. Prepares Medical staff credentialing recommendations for presentation to and action by the Board of Directors. Update database and send out correspondence.
- Date/time stamp incoming documents and screen for and resolve inconsistencies. Identify and flag adverse/questionable information for the purpose of conducting special follow-up investigation for use by the appropriate Medical Staff leadership and Medical Staff committees.
- Researches, documents and reports on individual credentials and qualifications of physicians and other practitioners/providers. Manages, tracks and reports on the review and approval of practitioner/provider privilege requests.
- Maintains, reviews and provides updates of the Credentialing Program administrative policy documents to the Credentials Committee, Medical Executive Committee and the Board of Directors.
- Documents and communicates the names, telephones numbers, addresses, staff status, approved privileges, and additional necessary statistical data for new and current appointees.
- Knowledge of Joint Commission, National Committee for Quality Assurance (NCQA) and state standards.
- Exposed to highly sensitive confidential information requires extreme confidentiality.
STANDARD QUALIFICATIONS
- Associate degree or 4 years of credentialing/and/or a combination of credentialing experience/ payor enrollment experience required.
- Requires experience in a hospital setting, minimum of one-year credentialing and administrative support knowledge.
- Current Certified Professional Credentialing Specialist (CPCS) is preferred. New applicants must achieve certification within three years of placement.
Other Qualifications:
- Basic knowledge of PC operations and keyboarding skills. Requires demonstrated proficiency and knowledge of Microsoft Office programs (word, spreadsheet, etc.). Familiarity with Medical/Professional credentialing database and software operations is highly desired. Ability to plan, organize and prioritize the credentialing processes effectively. Ability to think and work independently and maintain confidentiality and discreteness. Requires the ability to analyze and ensure appropriate documentation is maintained. Requires a high level of interpersonal and communication skills to communicate effectively with physicians, vendors, and licensed and unlicensed professional staff, vendors and other external customers.
- Beaumont Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
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