Credentialing Nurse Specialist Job at Jamestown Regional Medical Center
Overview:
Full-time, benefited position working 80 hours per pay period. Days of work are Monday - Friday 8:00am - 4:30pm, no weekends or holidays.
The Credentialing Specialist provides highly skilled support to the medical staff and serves as a representative for Medical Executive, Credentials and Medical Staff committees. The Credentialing Specialist works closely with Hospital Administration, Administrative Assistant to the President and the Quality Manager. This position is responsible for the professional staff credentialing process.
This position facilitates the enrollment program and system wide practitioner enrollment for the physician practices and serves as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.
Responsibilities:
Three to five years clinical experience.
!!$5,000 SIGN ON BONUS AVAILABLE FOR NEW EMPLOYEES!!
Full-time, benefited position working 80 hours per pay period. Days of work are Monday - Friday 8:00am - 4:30pm, no weekends or holidays.
The Credentialing Specialist provides highly skilled support to the medical staff and serves as a representative for Medical Executive, Credentials and Medical Staff committees. The Credentialing Specialist works closely with Hospital Administration, Administrative Assistant to the President and the Quality Manager. This position is responsible for the professional staff credentialing process.
This position facilitates the enrollment program and system wide practitioner enrollment for the physician practices and serves as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.
Responsibilities:
Credentialing Specialist functions:
Coordinates all aspects of assigned medical staff committees including compiling agenda material, accurately documenting minutes, compiling follow-up memos and letters, researching and preparing information for chairs, and providing professional assistance to various committee chairs regarding privileging, credentialing, reappointment, and medical staff rules and regulations as outlined in the credentials policies and medical staff bylaws.- Serves as a resource for hospital personnel and medical staff members regarding medical staff bylaws, rules and regulations, hospital and medical staff policies, regulatory requirements, and parliamentary procedure.
- Tracks and files credentialing requirements for the members of the medical staff utilizing online credentialing platform.
- Collects and compiles data for physician and allied health quality profiles to analyze practice patterns using data to determine performance. This includes working with administration, quality staff, and other hospital staff to identify sources of data and methods of presenting and analyzing data.
- Under direction, liaises between medical staff and administration, communicating sensitive and confidential issues including professional practice evaluation. Interacts directly with a variety of internal and external customers. Uses judgment and discretion to maintain peer review protection to hospital and medical staff.
- Understands and maintains an accurate, secure and updated database of physician and allied health information to query on basic demographic profiles including but not limited to staff privileges and status for other hospital departments and facilities requiring this information. Uses various internal databases to gather and analyze physician and allied health data used in the reappointment, professional practice evaluation, and quality improvement processes of the medical staff and board of directors.
- Assists the Credentials Committee with development of privilege criteria, privilege delineations and other documents necessary to an effective credentialing process.
- Coordinates processing of all aspects of provider and allied health credentialing and reappointment processes within appropriate timeframes ensuring the quality of the practitioners providing patient care. Assures the completeness and accuracy of the credentialing process and credentialing files. Requests additional information from external sources if necessary. Processes and maintains all medical staff files in accordance with applicable requirements. Monitors the progress of physicians through the provisional period, assisting the proctor with the appropriate procedures, documentation and time limits.
- Maintains a working knowledge of the Medical Staff Bylaws, Rules and Regulations and Medical Staff policies.
- Develops and communicates changes made to any Medical Staff Manual which includes Bylaws, Medical Staff Policies, Rules and Regulations, and Credentialing, assuring compliance with The Joint Commission standards.
- Coordinates orientation sessions for new providers and medical students.
- Maintains knowledge of standards of The Joint Commission and State/Federal regulations related to Medical Staff.
- Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
- Coordinates with the Quality & Risk Manager to establish a process to develop and maintain physician performance profiles, and to integrate the information into the credentialing process in compliance with state and federal statutes and regulations, accreditation standards, the Health Care Quality Improvement Act, and institutional requirements (Ongoing Profession Practice Evaluation & Focused Professional Practice Evaluation).
Provider Enrollment functions:
- Enters current and accurate provider information into various enrollment portals.
- Facilitates initial and/or re-enrollment applications.
- Ensures the enrollment documentation is authenticated, complete and accurate, and submitted to payer with necessary attachments.
- Coordinates re-enrollment dates and communicates application requirements for all providers requiring re-enrollment.
- Monitors the pending payer credentialing and takes any necessary action (which may include sending additional enrollment applications to the payer) to allow claims to be submitted for payment.
- Communicates with various payers, clinics, billing offices and practitioners, regarding the status of enrollments on an ongoing basis as the primary contact for all enrollment issues.
- Will communicate with Managed Care on an ongoing basis as to status of payer contracts and other various enrollment issues.
Registered Nurse or Licensed Practical Nurse; Baccalaureate Degree in Nursing preferred.
Three to five years clinical experience.
Please Note :
clarksqn.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, clarksqn.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.