Medical Staff Credentialing Manager jobs in Indiana

• Granger, IN
• Beacon Medical Staff Services
• Beacon Health System
• Full-time - Day - Monday - Friday 7:30 AM - 4:30 PM (flexible)
• Req #: 211925
Posted: April 24, 2024-->

Summary

Reports to the Director of Medical Staff Services. This position manages the provider appointment, reappointment and privileging process, and analyzes and manages data verification. This is accomplished through the accurate and timely processing of credentialing or re-credentialing applications according to Bylaws, Rules & Regulations, Policies and affiliated accrediting bodies (dependent on the facility assigned: Joint Commission, HFAP, and/or CMS). This position works closely with the officers of the medical staff, department chairs, and administration to support and enhance the functions of the Medical Staff.

MISSION, VALUES and SERVICE GOALS

• MISSION:We deliver outstanding care, inspire health, and connect with heart.
• VALUES:Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:Personally connect. Keep everyone informed. Be on their team.

Initial Credentialing and Reappointment:

• Obtains CV approval and submits an application to the practitioner within 48 hours of receipt.
• After approval of initial appointment, ensures system is updated with new status and privileges, and accessible to stakeholders and staff.
• Works with Managed Care, Central Verification Office (CVO), BMG Recruitment or others to obtain information on applicants.
• Perform file audits to ensure that all applications for initial appointment are complete and accurate.
• Maintains positive and proactive working relationships with others and provides timely and appropriate updates to credentialing status.
• Prepares individualized credential folders completely and in a timely manner for review by Department Chairmen and Credentials Committee.
• Ensure all associated regulations/standards are met.
• Prepares status reports of applicants to Credentials Committee, applicable hospital staff and Administration timely.
• Maintains current releases of information to satisfy hospitals' information requests or audits.
• Communicates practitioner appointments to hospital staff and administration.
• Answers the telephone promptly, professionally and pleasantly at all times.
• Maintains reappointment schedule for accurate and timely physician reappointment to the Medical Staff every two (2) years according to established guidelines and procedures.
• Distributes and processes reappointment information to the Medical Staff and their credentialing contact to ensure continuity of care.
• Inputs all reappointment information into credentialing database.
• After approval of reappointment and/or amended privileges, ensures system is updated with new status and privileges, and accessible to stakeholders and hospital staff.

Credentialing Committee Coordination:

• Coordinates, prepares agenda (with Chairman) and attends Credentialing Committee meetings.
• Prepares and organizes all information going to Credentialing Committee.
• Follows up timely on all information/recommendations from Credentialing Committee to ensure timely progress of applicants and/or privilege changes.
• Responds to requests from practitioners, office managers, managed care organizations and Administration on the status of applicants in a timely and professional manner.
• Prepares timely agenda with Chairman, records minutes, and distributes information forotherMedical Staff meetings.
• Submit committee policies for review on a periodic basis.
• Maintains positive and proactive working relationships with Committee Chairmen and Members.
• Communicates action and directions from Medical Staff departments/committees to all appropriate area.

Executive Committee Coordination:

• Assists with timely collection and assembly of MEC agenda packets, maintenance of accurate meeting minutes, as well as appropriate follow-up.
• Maintaining and updating credentialing and privileging forms for all specialty practitioners, allied health professionals, and mid-level practitioners.
• Maintaining any provisional and/or proctoring time periods and coordinating the collection of evaluation forms required, obtaining recommendations by the department chairs and medical staff committees, forwarding information to the Board and performing all follow up as required within time frames established in bylaws and/or policy.
• Processing specific clinical privilege requests during interim periods not associated with initial appointment or reappointment.
• Collaborating with the Manager, Medical Staff Services and/or the VP, Medical Affairs as necessary when issues of criteria and/or qualifications are unclear and/or other issues arise as a result of these requests.

Credentialing Administration and Database Maintenance:

• Maintains accurate and timely database information on practitioners on staff for optimal communication.
• Prepares and maintains key elements accurately on database so that information may be submitted for appropriate requests in a timely manner.
• Process and prepares membership and privilege change request through appropriate department and committees.
• Process and notifies appropriate departments regarding resignation notices.
• Maintains strict confidentiality of all credentialing information to protect the applicant, hospital and Beacon Health System from any potential liability.
• Maintains thorough knowledge of ISDH and other regulatory requirements having jurisdiction over credentialing and attends audits.
• Maintain and update privilege profiles to ensure accuracy on all databases.
• Recommends, builds, and provides periodic updates to privilege delineation forms and submits for authorization.
• Compiles, reports and responds to the annual Medicare Quality Improvement Organization for Physician Acknowledgement (CMS).
• Responds to requests for medical staff verifications from external hospitals and facilities in a timely manner.
• Scans necessary documents in appropriate credentialing file on the credentialing database in a timely manner.
• Provides roster of Medical Staff/AHP's as requested by hospital administration or medical staff officers in accordance with medical staff criteria.
• Reports issues regarding credentialing contracted services or credentialing software to Medical Staff Services Manager.
• Request application access for staff members through AMS.
• Meet and comply with regulatory body's audits and inquiries.

Serves as a resource for compliance with internal and external standards, including accrediting and regulatory agencies, as they apply to the medical staff organization by:

• Maintaining current working knowledge of internal medical staff bylaws, rules and regulations, and policies and procedures.
• Maintaining current working knowledge of external accrediting standards (such as Joint Commission, HFAP, and/or CMS) as well as state and federal regulatory requirements;
• Providing medical staff and administration with appropriate interpretation of standards/requirements.
• Participating in development and revision of documents to ensure compliance.

Serves as liaison between medical staff, administration, and other departments and ensures customer service is provided by the Medical Staff Services by:

• Maintaining excellent working relationship with medical staff leaders and other members of the medical staff.
• Maintaining excellent communication with administration and other relevant departments.
• Assisting medical staff members, when requested, and providing necessary reports to medical staff, administration, and other departments as required.
• Ensuring the communication of information between medical staff departments, Credentials Committee, and the Medical Executive Committee (when appropriate) and following through on all recommended correspondence and/or direction; channeling action from one meeting to another.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Completes other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills, and abilities as indicated below are normally acquired through the successful completion of a High School Diploma (or equivalent) and specialized training as a Medical Staff Professional (MSP). Current Certified Provider Credentialing Specialist (CPCS) certification as recognized by the National Association Medical Staff Services (NAMSS) is desired. After completion of (3) three years of full-time employment with Beacon Health System, successful attainment of CPCS certification is required. One to three years of prior experience in Medical Staff Services, with documented Medical Staff experience in credentialing, re-credentialing, and knowledge of accreditation standards (i.e. Joint Commission, HFAP, CMS, etc.), along with current CPCS or CPMSM certification is desired. Successful completion of an Associate's Degree (or two years equivalent training and experience) is preferred. Attainment of Certified Professional Medical Services Management (CPMSM) certification as recognized by the National Association Medical Staff Services (NAMSS) is suggested after completion of (5) five years of full-time employment with Beacon Health System.

Knowledge and Skills

• Ability with demonstrated competence in the Microsoft Suite of products.
• Written and oral communication is desired with emphasis on professionalism, grammar, medical terminology.
• Basic knowledge of Joint Commission, HFAP and/or CMS Accreditation Standards related to the organized medical staff.
• Respect for the importance of confidentiality.
• Basic knowledge of medical staff services, principles, methods and procedures.
• Knowledge of federal, state, and local laws and regulations applicable to assigned area.
• Demonstrates ability to establish and maintain effective working relationships with medical staff and other healthcare officials.
• Demonstrates ability to handle a variety of problems and situations, sometimes of a critical or urgent nature.
• Demonstrates ability to express ideas effectively, verbally, and in writing.
• Requires independent problem solving and decision making ability, flexibility, perseverance and fortitude.

Working Conditions

• Prolonged sitting and use of computers.
• Requires the ability to work flexible hours, including early and after hours meeting requirements.
• Must be able to cope with interruptions, various personalities, rush projects and a demanding medical staff.
• Travel to other locations within Beacon may be required.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.