Medical Staff Credentials Coordinator in Oakland, California at Alameda Health System

SUMMARY: Responsible for all aspects of the credentialing and privileging process and reappointment process for affiliated medical staff and advanced practice providers to ensure the highest quality patient care at Alameda Health System. Responsible for collecting primary source verifications and analyzing and accurately updating data that is collected to ensure compliance with established criteria. Collaboration with Medical Staff Leadership, Administration and the Medical Staff Services Department to ensure compliance with Medical Staff Bylaws, organizational policies, legal and regulatory requirements.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Responsible for the coordination of all aspects of the credentialing, privileging and ongoing monitoring for the Medical Staff including but not limited to the maintenance of accurate, up-to-date files.

2. Conducts primary source verification of provider applications with multiple entities as outlined in the Medical Staff policy and as required by the applicable regulatory agencies in a timely and efficient manner.

3. Maintains accuracy of the Medical Staff Services database.

4. Responds to questions regarding expiring credentials, uploads renewed credentials into the database, maintains the database system as required, and ensures data integrity.

5. Prepares and presents complete application material, flagging any concerns, for recommendation l in accordance with the medical staff policies and bylaws.

6. Accountable for the utilization of any computer software program(s) necessary to support the credentialing process and maintaining the database including but not limited to data entry, scanning documents, and maintaining data sufficient to prepopulate applications supported by the database.

7. Collaborates with the quality department to implement principles of ongoing professional practice improvement and focused professional practice improvement are utilized within the Medical Staffs.

8. Coordinates responses to inquiries regarding applications; follows up until complete; assesses provider credentialing files to determine if additional information is required; revisits state and federal bulletins for provider sanctions.

9. Facilitates medical staff committee meetings including meeting reminders, agendas, minutes reflective of the discussions and actions taken and performs follow up.

10. Participates in surveys by regulatory bodies (TJC, NCQA, CMS, federal and state) and health plan audits.

11. Responsible for the management and oversight for the Focused Professional Practice Evaluation (proctoring) process for all initial appointments and any privilege modifications.

12. Reviews and processes mail and/or interdepartmental correspondence as received.

13. Works with providers and payers to facilitate issue resolution, enrollment, re-enrollment, and termination requirements as needed.

14. Maintains confidentiality of all provider information within the credentialing database, as well as documentation gathered through the credentialing process.

15. Perform other related duties as assigned.

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

MINIMUM QUALIFICATIONS:

Required Education: Associate’s degree in Business or Healthcare Administration or combination of equivalent education, training, and experience in a related field.

Required Experience: Two (2) years in credentialing/privileging.

Preferred Experience: Recent experience credentialing/privileging providers in a hospital/acute care setting.

Preferred Licenses/Certifications: Certification from the National Association of Medical Staff Services as either a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).