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CREDENTIALING COORD MANAGED CR
Pool (PRN) FTE .0001
Performs duties related to the Medical Staff Office functions, which include but are not limited to credentialing new and established healthcare providers, maintaining information which includes primary source verification, follow-up, data collection, data entry, and document review. Participates in all facets of medical staff meetings, which includes scheduling, distributing notices, recording minutes. Participates in quality studies. Performs other duties, as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Maintains high quality, timely and accurate credentialing processes of medical and allied healthcare professionals based upon system policies and procedures.
- Assists in the credentialing process by entering, logging, scanning information into the system for initial appointments, reappointments, add-on applications and maintenance.
- Completes and ensures compliance and delivery of required information to all customers in a timely manner.
- Processes and maintains credentialing and recredentialing in accordance with Mercy policies and procedures, Joint Commission standards, State and Federal regulatory guidelines.
- Ensures that all credentials are current and complete pursuant to expiration date of medical licensure, board certification, professional liability insurance coverage, DEA and other pertinent information per Mercy policy/procedure.
- Monitors collection of all information received. Follow-up on missing items/documentation/incomplete forms. Submits follow-up requests, as needed.
- Identifies and evaluates potential red flags and works in collaboration with practitioner(s) to document the issue and practitioner response.
- Advises supervisor and/or director of questionable information received and any issues identified during processes.
- Submits closed files for audit/final review and secures missing items as identified by audit/final review.
- Maintains all credentials files to ensure that all correspondence is accurately filed; is knowledgeable and current in regard to process and legal/regulatory requirements.
- Maintains compliance with Mercy policies/procedures, federal, state and all accrediting agencies as required.
- Responds to verification requests from hospitals and managed care organizations. Orders Medical Staff Office supplies. Bills for Medical Staff dues. Works with agencies and practitioners to assemble credentials files and arranges for review and secures signatures for locum tenens privileges. Serves as a resource for the Medical Staff on Medical Staff Bylaws issues. Assists physicians in developing criteria for privileging. Schedules and secures rooms for Medical Staff meetings, sends out notices, drafts agenda, assembles meeting materials, drafts minutes and follow-up correspondence. Maintains information in CACTUS database. Produces labels and writes reports from database. Maintains meeting attendance records in CACTUS database. Maintains Mercy sponsored CME records in CACTUS database.
CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS
To perform the job successfully, an individual should demonstrate the following behavior expectations:
Quality- Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.
Service- Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.
Partnering- Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.
Cost- Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.
EDUCATION & EXPERIENCE
Associate's degree required with a minimum of one-year experience in healthcare credentialing (healthcare facility, managed care setting, CVO, or medical staff office).
Or equivalent combination of education and experience with Bachelor’s degree preferred.
CPMSM or CPCS preferred or commitment to pursue certification within one year.
Passing the Driver’s License Check and/or Credit Check (for those positions requiring).
Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.
Must be able to follow written/oral instructions.
OTHER SKILLS AND ABILITIES
Experience with credentialing accreditation by The Joint Commission or NCQA.
Demonstrated working knowledge of healthcare and credentialing industry, including medicolegal issues and laws, regulatory agencies, and other national standards preferred.
Understanding of professional telephone etiquette.
Able to work with minimal supervision and under pressure. Able to work well in individual and group environment.
Proactively prioritizes needs. Shows attention to detail.
Communicates clearly and concisely. Must have excellent interpersonal and written communication skills, including spelling, grammar and basic mathematical calculations.
Establishes and maintains long-term customer relationships by building trust and respect.
Articulates knowledge and understanding or organizational policies, procedures, systems.
Demonstrates proficiency in Microsoft Office (Word, Excel, Access) and other applications, as required. Demonstrates knowledge of credentialing software; Cactus preferred, with completion of post-Cactus training testing of 90% or greater.
Maintains confidentiality of privileged information.
Knowledge of accepted practices related to primary source verification.
The noise level in the work environment is usually quiet.
Occupational Exposure: Category C -No partners in the specified job classification have occupational exposure.
AGE OF PATIENTS SERVED
Non-Specific Task (N/A)
Partner may access patient care information needed to perform their job duties.
WORK CONTACT GROUP
All system partners including physicians, all customer groups including community, other healthcare professionals.
SPECIAL PHYSICAL DEMANDS
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
In order to perform the demands of this job, the employee may sit for long periods, exerting up to 10 pounds of force occasionally, walking and standing occasionally. The employee is required to frequently reach with hands and arms, finger, handle, talk and hear. Manual dexterity is required.
LEVEL OF SUPERVISION
Some independent judgement is required, but alternatives are limited by standard practices and procedures.