Primary Function
Provides support and coordination for all medical staff credentialing needs. Maintains productive, professional relationships with all levels of staff. Develops departmental plans, budgets and directs staff as appropriate. Maintains knowledge of current medical staff credentialing standards as related to deemed agencies, State Law and other regulations to assure compliance.
Responsibilities
Nature and Scope (Essential Functions)
Responsibilities include but not limited to:
• Demonstrates and maintains knowledge of current standards relating to medical staff credentialing, and requirements of deemed agencies.
• Consults with other departments as it relates to credentialing function to collaborate in patient care and performance improvement activities.
• Keeps abreast of government and intermediary requirements.
• Assists and provides information for internal and external audits as requested.
• Assures that appropriate reports are submitted to regulatory agencies as required.
• Maintains complete knowledge of hospital policy, state and federal laws governing areas of responsibility.
• Ensures that Centralize Medical Staff Credentialing Office staff conducts all business in a secure manner, protecting the confidentiality of all medical staff members and proceedings, as legally and ethically required.
• Supervises Centralize Medical Staff Credentialing personnel and is responsible to ensure that all credentialing activities are complete, appropriate and comply with administrative and medical staff policy, as well as regulatory expectations and standards.
• Identifies credentialing issues, irregularities and ensures that they are dealt with in an appropriate manner.
• Keeps immediate supervisor informed of potential problems relating to pending applications or reapplications, or applicants/reapplicants who may not meet the criteria for membership.
• Develops processes that facilitate credentialing, incorporating regulatory changes as mandated and addressed standard expectations and changes.
• Ensure that there is a functioning process within the hospital to notify appropriate staff regarding current privileges.
• Demonstrates an ability to maintain a professional, friendly relationship with all medical staff in an effort to assure and facilitate their membership and credentialing process.
• Assists Hospital and Program Director(s) in maintaining current accreditation status by complying with basic standards and regulations.
• Assists Administrator and hospital management with any special projects relating to requirements by deemed agencies.
• Recognizes and responds to priorities, accepts changes and new ideas. Has insight into problems and the ability to develop workable alternatives.
• Accepts constructive criticism in a positive manner. Recognizes and responds to priorities, accepts changes and new ideas. Has insight into problems and the ability to develop workable alternatives.
• Adheres to attendance and punctuality requirements per hospital policy. Provides proper notification for absences and tardiness. Takes corrective action to prevent recurring absences or tardiness.
• Uses time effectively and constructively. Does not abuse supplies, equipment, and service.
• Observes all hospital and departmental policies governing conduct while at work (e.g., telephone and computer use, electronic messaging, smoking regulations, parking, breaks and other related policies).
• Patient-Centered
o Respectful of and responds to patients preferences, values and needs.
o Understand, respects and displays sensitivity to culture, age and persons with disabilities.
o Compassionate and empathetic in any interaction with patient, family or peers.
• Accountability & Customer Focused
o Participates actively and positively affects the outcomes of customer service activities.
o Takes pride in the place of work and in one’s job every day. Ownership in one’s hospital.
• Teamwork & Communication
o Committed to the “internal customer.”
Positive, proactive, collaborative, helpful and caring to coworkers and colleagues.
Developing peer relationships that enable the work group to accomplish the daily workload within the allotted time frame and achieve departmental goals.
o Utilize respectful language, tone, body language and communication with patient, family, loved ones and peers. Communicate in a way they understand on the phone, in person, and all forms of interaction.
o Timely and meets deadlines both internally and externally
Notification to Department manager/Director of potential problem or concerns. When faced with a problem or concern, is proactive by presenting suggested solutions at the time that the Department manager/Director is made aware of the problem or concern.
Effective and timely processing of customer’s requests according to hospital and departmental policies.
o Supports Patient Rights.
o Using written communication that is legible, timely and at a level based on the position specific requirements.
o Listening attentively to ensure effective two-way communication.
o Expressing and accepting feedback in a professional manner.
• Privacy & Safety
o Observes dress code policy and wears hospital identification as required by our policies and procedures.
o Follow and abide by all privacy (HIPAA) regulations regarding patient information.
• Attitude & Respect
o Being sensitive to customer’s emotions, thoughts and feelings by being culturally aware of their preferences and cultural norms.
o Leading by example by emphasizing and highlighting the positive details of a situation or behaviors of others.
o Interacts with coworkers, other hospital staff, physicians, and the public in a courteous, professional and efficient manner.
o Establishes good rapport and working relationships with coworkers, other hospital staff, physicians and the public. Creating this rapport by exhibiting dependable, empathetic, trustworthy and compassionate behavior.
o Displays behavior that exhibits a commitment to providing the best quality care both clinical and emotionally to patients, family and peers.
• Understands and abides by all departmental policies and procedures as well as the Codes of Ethics, HIPAA requirements and patient rights.
• Complies with Federal, State, and Local Laws that govern business practices. Complies with all deemed agencies requirements and standards that apply to the position.
• Is knowledgeable of the requirements by deemed agencies. Demonstrated knowledge and adheres to JCAHO/DHS/CMS standards specific to the position.
• Participates actively in ensuring that all State and Federal Rules and Regulations are followed as they apply to this position.
• Conducts business in an ethical and trustworthy manner at all times when dealing with patients, visitors, physicians, and fellow employees.
• Attends scheduled in-services and mandatory in-service. Communicates ideas to supervisor for a safer layout of equipment, tools, and/or processes.
• Follows standard precautions and transmission-based precautions as shown by consistent use of appropriate personal protective equipment.
• Uses proper body mechanics at all times. Seeks assistance when necessary to move heavy objects.
• Is knowledgeable in the hospital safety program and takes necessary steps to maintain a safe environment. Adheres to safe work practices in order to prevent injuries and illnesses.
• Is familiar with emergency codes and emergency preparedness procedures and understands his/her role in response to each of the emergency codes (Code Blue, Code Pink, Code Orange, Code Yellow, Code Gray, Code Silver, Code Purple, etc.).
• Maintains the department in a neat, clean, and orderly manner, especially in own work area.
• Eliminates or assists in eliminating any seen or known hazards in the workplace. Reports any unsafe conditions to his or her immediate supervisor.
• Demonstrates good safety habits and judgment by maintaining a safe environment at all times.
• Complies with all hospital safety and injury prevention policies and regulations.
• Understands the Continuous Quality Improvement Process and applies it in performing everyday tasks/duties. Active participant in Continuous Quality Improvement program by assisting in finding new and better ways of performing duties and responsibilities.
• Understands performance improvement concepts and demonstrates understanding by:
o Defining performance improvement, and verbalizing at least one major goal of the performance improvement program within the hospital setting.
o Ability to describe a quality improvement problem solving process and how its use assists in reaching improving patient outcomes and/or organizational quality improvement goals.
o Able to verbalize at least one departmental or hospital wide improvement initiative that has occurred within the last 12 months.
• Cooperates with others in the improvement of services offered at our institution. Continually makes recommendations that assist in the improvement of services.
• Continually strives for self-improvement in areas of responsibility by attending continuing education classes.
• Independently recognizes and performs duties that need to be done without being directly assigned. Establishes priorities; organizes work and time to meet them.
• Performs other duties as assigned or required.
Qualifications
Qualifications
1. Bachelor's degree preferred or equivalent education/experience.
2. Certified Provider Credentialing Specialist (CPCS), or equivalent, preferred.
3. Minimum of five years in one of the following venues: hospitals, managed care, credentialing verification organizations, or ambulatory care. Two years in medical staff credentialing services is required. Experience in working with governance processes is essential.
4. Previous lead/supervisory experience preferred.
5. Must have strong computer, communication and writing skills with knowledge of medical terminology.
6. Must obtain Sexual Harassment Certification within 6 months and then maintain current biennially.
7. Knowledge of federal, state and local healthcare regulations.
8. Knowledge of HIPAA and privacy regulations.
9. Possess excellent grammar, composition, and communication skills.
10. Ability to communicate effectively with internal and external resources.
11. Excellent oral and written skills.
12. Ability to work independently.
13. Must possess excellent human relation skills.
14. Must possess excellent critical thinking skills.
15. Possess strong organizational skills with ability to multi-task, and prioritize workload.
16. Ability to interpret, prepare, and present reports to management in both written and oral formats.
17. Ability to make presentations, design and provide training education to staff and management.
Accountability
1. The incumbent is responsible for the oversight of the timely processing of medical staff applications and reapplications.
2. The incumbent is responsible for directing the development and coordination of specific projects assigned.
3. This position is responsible for promoting an environment of teamwork with all members of the organization.
4. The incumbent is responsible for assuring the assigned projects are completed in a timely and efficient manner.
5. The incumbent is responsible for developing and training staff as necessary in order to execute new programs, and/or initiatives.
6. The incumbent is responsible for coordinating with internal and external resources to ensure the success of the assigned projects.
7. This position is responsible for assuring all stakeholders are well informed and have the tools necessary to execute as needed.
8. The incumbent is accountable for communicating to immediate supervisor of any possible issues, which may arise in order to proactively develop an action plan to minimize or eliminate the issue.
9. The incumbent is responsible for acting in an ethical manner at all times.
10. The incumbent is accountable for maintaining confidentiality.
11. The incumbent is responsible for complying with all company policies and procedures.
Hospital Description
Dimensions
AHMC consists of a corporate office and eight acute care hospitals, and one skilled nursing facility, AHMC Anaheim Regional Medical Center 228 beds, Doctors Hospital of Riverside/Parkview with 191 beds, Garfield Medical Center with 211 beds, Greater El Monte Community Hospital with 115 beds, Monterey Park Hospital with 102 beds, San Gabriel Valley Medical Center with 273 beds, Seton Medical Center with 357 beds, Seton Medical Center Coastside a 116-bed skilled nursing facility, and Whittier Hospital Medical Center with 172 beds. The facilities are Medicare and MediCal certified and accredited by the Joint Commission on Accreditation of Healthcare Organizations. The hospitals provide healthcare services reimbursed by Medicare, MediCal, traditional insurance plans, PPO, HMO and under capitated arrangements.
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