Credentialing Specialist - Medical Group
Baylor Scott & White Health
**JOB SUMMARY**
+ Training 100% onsite - 2 weeks
+ If cleared after training, will go to HYBRID schedule - 2 days in office/3 days remote for 60 days
+ If not cleared after training, will remain onsite
+ Once successful clearance from training and completes 60 days as 2/3 working independently, schedule will change to 5 days remote but 1 day a month in office.
+ Under general supervision, accountable for all functions relating to the administrative work in coordinating credentialing and re-credentialing and the clinical privileging of the medical staff/medical group and delineation of services for the allied health professionals and others as appropriate for the Baylor Scott & White Health.
+ Accountable for the accuracy and integrity of the credentialing and clinical privileging database system.
+ Functions as a member of the team to assure optimum performance of the department.
+ Provides information and guidance about medical staff/medical group bylaws/policies, medical staff/medical group rules and regulations, allied health professionals (AHP) policies, Joint Commission for Accreditation of Healthcare Organizations (JCAHO) and Center for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA) and other regulatory agencies as they pertain to medical staff/medical group and allied health professionals.
+ Requires Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or **education plan to obtain in eighteen (18) months from date of hire.**
**ESSENTIAL FUNCTIONS OF THE ROLE**
+ Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff/medical group and allied health professionals in compliance with the medical staff/medical group bylaws, medical staff/medical group policies and procedures, AHP policies, JCAHO, CMS, NCQA standards and other regulatory agencies including payer delegation agreements.
+ Processes confidential medical staff/medical group and allied health professional files requests for, but not limited to new applications, reappointment applications, temporary applications, more privileges, staff category changes, resignations / retirement.
+ Maintains data integrity of the credentialing and clinical privileging software system. According to established policies and procedures, accountable for the integrity of data
+ Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet.
+ Ensures maintenance of medical staff/medical group and allied health professional files.
+ Ensures that results of medical staff/medical group quality management findings are provided to appropriate review committees/ departments and maintained in a confidential file.
+ Maintains a working knowledge of the medical staff/medical group bylaws, medical staff/medical group rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.
+ Acts as a liaison between the medical staff/medical group, allied health professionals, nursing services and administration, practice operations and recruitment.
+ Performs other duties as required. Job duties are subject to changes as directed by management.
+ Accountable for recording and maintaining medical group credentialing status, clinical privileges for physicians and allied health staff members in the database.
**BENEFITS**
Our competitive benefits package includes the following
+ Immediate eligibility for health and welfare benefits
+ 401(k) savings plan with dollar-for-dollar match up to 5%
+ Tuition Reimbursement
+ PTO accrual beginning Day 1
Note: Benefits may vary based on position type and/or level
**QUALIFICATIONS**
+ EDUCATION - Bachelor's
+ Must be a completed bachelor's degree
+ Bachelor's degree in progress will not pass minimal qualifications for this position
+ EXPERIENCE - 10 Years of Experience
+ 10 year requirement is total work experience
+ Does not have to be 10 years in Credentialing
+ Working in healthcare a plus
+ Certification a plus but BSWH allows up to 18m to obtain.
+ Understanding onboarding for physicians also a plus
As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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