The Credentials Evaluation Analyst provides mentorship and support to medical staff leadership in the evaluation of credentials and practice information as it relates to the granting of Medical Network credentials.
Contributes to the planning, structuring and monitoring of credentialing activities, and assists with high-profile / sensitive credentialing projects.
Works in collaboration to implement the best standard methodologies, recommends policy / procedure changes and provides input about work products.
Duties and Responsibilities :
Collaborate with the Credentialing Logistics Department. Evaluates individual practitioner credentials files (both electronic and paper files) to ensure that information acquired from the Credentials Coordinators / Credentials QC Analysts meets established specifications.
Pursues additional information as ne. Investigates issues of concern in cooperation with applicable individuals and / or departments.
Raises and makes recommendations to resolve issues that do not conform to established expectations to Credentialing Manager or consultation with other appropriate collaborators as required.
Assess practitioner files to determine the presence or absence of possibly adverse or incomplete information that may impact Medical Network credentialing decisions in accordance with established criteria.
Pursues problematic, missing or incomplete information in conformance with established procedures. Summarizes the results of the assessment in the file audit summary report.
Evaluates credentials / qualifications against credentialing criteria. Assesses data / information provided against criteria for credentials requested and recommend actions for resolution.
Pursues problematic, missing or incomplete information in conformance with established procedures. Summarizes the results of the assessment in the file audit summary report.
- Maintains lines of communication on work products and evolving issues of concern with regard to applicants / re-applicants with CMO / Medical Director, Quality Credentials QC Analysts / Coordinators, clinical department managers and Clinical Privileging Quality Manager, as applicable.
- Supports Practitioner Evaluation. Serves as a liaison and provides support for the pre-Credentials Committee review (as applicable) of both initial applicants and applicants for renewal.
Facilitates a detailed and comprehensive evaluation as related to granting, continuing, denying or rescinding Medical Network credentials.
Collaborates with Patient Safety and Peer Review Department. Collaborates with applicable individuals regarding related peer review and quality issues to improve the identification of professional practice trends that impact quality of care and patient safety.
Ensures that the results of these evaluations are considered by the CMO / Medical Director, Quality when recommendations regarding continued credentialing occur.
- Acts as a resource. Provide expert internal consultation and facilitation to collaborators regarding credentialing matters related to assigned specialties.
- Identifies and works to implement the best standard processes. Makes recommendations to policy / procedure changes. Works to resolve issues related to high-profile and critical credentialing projects with the help of the privileging manager.
- Performs data entry of information into MSOW in accordance with established guidelines. Works accurately to ensure the integrity of data entered into MSOW.
Uses MSOW including work processes, jobs and tasks and maintenance of fields in accordance with established standards. Completes training and maintains proficiency throughout MSOW development.
Day to day work reflects an understanding of departmental operations, including the achievement of goals and objectives.
Assists in research and development of department protocols and privilege forms to reflect clinical practice advances and changes in regulatory requirements.
Participates in departmental activities that improve processes and efficiency and reduce waste.
Education :
High school diploma / GED required. Associate degree / College diploma / Bachelor's degree in Credentialing / privileging or healthcare related field of study preferred.
Experience :
Three (3) years of experience in a clinical credentialing required.
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