Position Summary:

The Medical Staff Specialist is accountable for ensuring the hospital credentialing and privileging processes (including but not limited to primary source verifications, analysis and evaluation of verifications and privileges requested, and completion of application for Credentials Committee) are completed efficiently and effectively in accordance with established regulatory agencies, accreditation organizations, Medical and Dental Staff Bylaws, and Hospital and Medical Staff policies for initial applicants and reapplicants to the Medical and Dental Staff.

Essential Job Functions:

• Credentialing initial appointments: Releases all initial applications and criteria for membership and status through the Pre-Application Process. Receives, processes and evaluates all applications for completion. Performs primary source verification to include receipt of responses and follow-up. Analyzes all information and documents received and makes decisions to accept, to initiate further investigation, or escalate review to Manager. Prepares completed applications for review from quality review to review by Credentials Committee.
• Privileging for initial applicants: When clinical privileges are requested on Pre-Application, releases delineation of clinical privileges forms and related criteria. Receives, processes, and evaluates for completion. Performs primary source verification of criteria for each privilege requested. Analyzes verifications against privileges requested, and makes decisions to accept, to initiate further investigation, or escalate review to Manager. Prepares completed requests for privileges for review from quality review to review by the Credentials Committee.
• Reappointments and renewal of clinical privileges: Ensures forms are edited annually and maintained in compliance with current regulatory, accreditation and organization standards. Prepares and maintains reappointment data reports in MSO for Windows program. Evaluates the volume of reappointments to be processed, makes decisions on how reappointments will be processed and advises Manager. Ensures efficient and timely process of reappointment applications and renewals of privileges. Analyzes primary source verifications and quality reports and makes decision to accept, to initiate further investigation, or escalate review to Manager. Completes reappointments and renewal of privileges to the review by Credentials Committee.
• Provides guidance and assistance to applicants and reapplicants, division and department heads, practice administrators or managers, and partner representatives such as PFF, CMMG, CSF, and CCPA, on initial and reappointment application deficiencies, standards of regulatory agencies, accreditation organizations, bylaws or hospital and medical staff policies, and any other issues relative to the credentialing and privileging process.
• Receives and processes all requests for temporary privileges and additional privileges, ensuring regulatory, accreditation and organizational policy compliance. Analyzes requests and makes decisions to forward for approval based on completeness of request and established criteria and policy.

FTE status: FT-80

Requirements

• Bachelor's degree in business, organization management or health care related degree preferred or minimum three years experience in medical staff credentialing and recredentialing process.
• Certification/Licensure/Registration. Certification by National Association of Medical Staff Services as a Credentialing Specialist (CPCS) is preferred or minimum three years experience in medical staff credentialing and recredentialing process.
• Working knowledge of regulatory and accrediting organization standards.
• Must have experience with a JCAHO or NCQA audit.
• Extensive knowledge and experience working with Microsoft applications such as Microsoft Word, Excel, Access, PowerPoint and Visio with the ability to operate standard office equipment (examples: photocopy machine, facsimile machine, calculator, etc.). Ability to type at least 40 wpm is preferred.
• Ability to work under pressure, handle numerous interruptions without losing the attention to details of the task interrupted, be detail oriented, and have excellent cognitive and communication skills.