Ensures the timely completion of an application for initial and/or re-credentialing by assisting the applicant in submitting all documentation necessary to process the application. Performs a variety of credentialing tasks at the direction of CVO management to complete the credentialing process for Trinity Health RHMs.
This position is an integral part of the credentialing team and is responsible for following credentialing policies and procedures; maintaining an accurate physician data base; collecting data; and participating in development and implementation of changes to the credentialing processes.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Assists the Manager in the identification and scheduling of reappointment candidates.
Performs file audits and provides feedback on completed initial and reappointment credentialing files.
Assists in the training and orientation of new team members.
Assists in daily data entry to ensure an accurate physician data base.
Facilitates the integration of new RHMs into the CVO by assisting with data entry and/or data conversion into the physician data base.
Communicates regularly with applicants and the RHMs to complete all requirements of the credentialing criteria within specified timeframes.
Contacts various primary sources to gather the required verifications to complete the background investigation via telephone, fax transmissions, mailings and Internet to ensure rapid completion of the application.
Prepares documentation of all verifications including a summary of all verified references for each completed credentials file.
Assists in the reappointment process; collecting required information, verifying information, and completing appropriate follow-up to complete the reappointment application.
Meets processing time thresholds consistently and with minimal error.
Assists with the initial drafting of RHM privilege forms in the PCCB module of the credentialing data base.
Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and external entities.
Maintains a customer-focus attitude, good rapport, and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Tracks errors and complaints to assist with process improvement activities.
Participates in professional development programs and professional organizations to grow in understanding of the various regulations and legislation of the health care industry as appropriate.
Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to Trinity Health. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
Assumes responsibility for performance of job duties in the safest possible manner, to ensure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
Performs other duties as needed and assigned by the Director.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
MINIMUM QUALIFICATIONS
Must possess two years of post-high school education, training, or experience. Associate degree in health administration or a related field preferred.
One year of work experience in the health care environment and general knowledge of the health care industry including hospital settings, physician practices, and managed care organizations.
Knowledge and understanding of NCQA and TJC standards, NPDB guidelines, hospital policies and procedures, and general licensing regulations.
Knowledge and experience with database organization and management, report generating languages, PC's and proficiency in Windows-based word processing software.
Current CPCS and/or CPMSM eligibility by the National Association Medical Staff Services preferred but not required.
Strong communication skills including the ability to correspond effectively, as well as verbally convey information clearly, listen actively, and consider varying viewpoints when making decisions. Strong statistical, analytical and problem-solving skills. Ability and desire to provide quality service to others. Strong organizational skills and the ability to provide attention to detail and thoroughness. Ability to work autonomously and within a team environment. Must possess the ability to comply with Trinity Health policies and procedures.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Ability to complete work during high-pressure periods while maintaining flexibility and a pleasant attitude.
Hourly Pay Range: $21.10 - $31.65
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.