CREDENTIALING ANALYST

General Summary of Position

Under the direction of the System Director, responsible for the administrative duties required in the credentialing primary source verification process.

Imports, enters, and maintains specialized applicant information into a complex database and coordinates the credentialing and primary source verification process for the Medical Staff offices of the respective MSH entities.

Ensures the credentialing and primary source verification process complies with organizational as well as an accrediting agency, Federal, and State regulatory standards.

Works in a team environment within the department and with the Medical Staff offices. Serves as a liaison between MSH-affiliated hospitals and Medical Staff Administration offices, MMG, and MedStar Family Choice.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards.

Complies with governmental and accreditation regulations.Tracks initial / re-credentialing application sent, received, and in-process.

In accordance with established policies & procedures and time frames, takes action on non-returned applications.Conducts primary source verification for all initial / re-credentialing applications in accordance with defined workflows and established policies and procedures.

Responsible for tracking all queries and performing subsequent queries, or, determining the need for another means of verification (other than routine form letter) in accordance with deadlines and priorities.

Responsible for the follow-up on missing data and / or discrepancies in accordance with established time frames and based on knowledge of general credential processes and needs of the clinical assignment.

As responses to queries received and information entered in database, compares information received with the information provided by the applicant to ensure accuracy and completeness.

Responsible for the completion of the verification process within established time frames to ensure the entity has time to complete entity-specific committee reviews prior to appointment / next reappointment date.

Imports all reapplications from the online application portal in accordance with the CVO policy for data standardization.

Maintains integrity of the credentialing database and all practitioner records. Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of imported data as well as data that may be entered manually.

Serves as a liaison with MSH affiliates and their medical staff administration departments, MMG and MFC, which includes providing effective and timely communication as the status of the application and any issues that may be identified.

May process initial / re-credentialing applications for those applications that have been deemed Participates in multi-disciplinary quality and service improvement teams.

Minimum Qualifications

Education

• High School Diploma or GED required
• Associate's degree or Bachelor's degree preferred

Experience

3-4 years Experience in credentialing or equivalent experience required

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) preferred
• Certified Medical Professional Services Management (CPMSM) preferred

Knowledge, Skills, and Abilities

• Working knowledge of general office practices and software applications (MS Office) and database management.
• Demonstrated understanding of credentialing policies and procedures and training program requirements as established by the CVO, as well as accreditation and regulatory requirements relating to the medical staff, specifically Joint Commission and NCQA.
• Organizational skills are required to handle the voluminous influx of credentialing applications and to prioritize tasks in order to meet cyclical deadlines.
• Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision.
• Analytical skills are necessary to determine whether correct and complete information was provided on applications.
• Meticulous attention to detail.
• Interacts with diverse groups of people within the Health System and with outside agencies.
• Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies. Handles sensitive and confidential situations / information, with a high degree of tact and diplomacy.
• Effective interpersonal skills and demonstrated written and verbal communication skills are necessary to interact with providers and both external and internal customers.
• Possesses excellent command of English; verbal, written (to include grammar and spelling), and reading comprehension.
• Exhibits excellent interpersonal skills, including those required for customer service.

This position has a hiring range of $23.19 - $38.49