Job Summary
The position will be responsible for receiving, processing, and validating new and renewed medical staff applications to ensure regulatory and bylaw compliance.
Responsibilities include provider data management, review of incoming provider applications, copying, filing, scanning, verification of credentials, correspondence, audit preparation and special projects as assigned.
Also will assist with on-line provider and group set up confirmations, enrollments and attestations.
Minimum Qualifications
- Minimum Education : Associate's Degree
- Minimum Years of Experience : 1 Year of work experience related to credentialing or other provider related regulatory process management / oversite
- Substitutable Education & Experience : Associate’s Degree with 1 year of work experience can be substituted for a High School Diploma or Equivalent with 4 years of experience related to credentialing or other provider related regulatory process management / oversite
- Required Certifications / Licensure : None
- Required Training : General knowledge of health care provider credentialing process for initial and reappointment applicants;
- Proficient in database, spreadsheet and word processing applications; Ability to perform multiple tasks in a pressured environment (handle stressful situations;
critical timelines); Ability to adapt and apply skills across varied department environments; General knowledge of medical ethics and medical terminology and confidentiality.
Essential Functions
- Maintains a comprehensive credentialing database, ensuring data integrity of provider information.
- Maintains provider charts according to specific chart structure, including imaging, filing, faxing and copying of confidential applications, correspondence and other provider data.
- Utilizes information, optimizing efficiency and performs necessary queries to prepare reports, document generation, provider packets, summaries and timelines as appropriate.
- Assists with internal credentialing monitoring to ensure compliance with regulatory bodies
- DNV, AHA, STS, NCDR, CMS, federal and state) as well as Professional Staff Policies and procedures and bylaws.
- Participates in audits both on and off site through chart review, process review and demonstration of on-going compliance and timeliness.
- Assists with the processing, distribution and management of all credentialing and accreditation documents.
- Assists with the administration and coordination of updated provider licensing, ensuring receipt within regulation parameters and requirements.
- Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
Duties & Responsibilities
- Monitors and communicates training requirements as a part of orientation to the credentialing and privileging program as well as other required training throughout provider participation.
- Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day to day credentialing and privileging issues as they arise.
- Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
- Utilizes the MD-Staff credentialing database, optimizing efficiency, and performs all necessary queries, report(s), and document generation;
submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
- Develops harmonious relationships with various providers and departments.
- Maintains and ensures strict confidentiality of files and databases.
- Performs all other duties as assigned.
We are committed to offering quality, cost-effective benefits choices for our employees and their families :
- Day ONE medical, dental and life insurance benefits
- Health care and dependent care flexible spending accounts (FSAs)
- Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
- Employer paid life insurance equal to 1x salary
- Employee may elect supplemental life insurance with low cost premiums up to 3x salary
- Adoption assistance
- LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
- Tuition reimbursement
- Student loan forgiveness