Penn State Health Credentialing Specialist - Med Staff Admin in Reading, Pennsylvania
Penn State Health St. Joseph Regional Health Network
Work Type: Full Time
Hours: 7:30a - 4:00p
Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of SJMC credentialing, including initial appointment, reappointment, expirables process, as well as clinical privileging for Medical Staff, Allied Health Professionals, and all other providers outlined in the SJMC Medical Staff Bylaws, policies, or related contracts. Oversees process for requesting temporary clinical privileges Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Medical Staff Services.
DUTIES AND RESPONSIBILITIES:
1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
2. Conducts thorough background investigation, research and primary source verification of all components of the application file.
3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
4. Prepares credentials file for completion and presentation to SJMC Medical Staff Committees, ensuring file completion within time periods specified.
5. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
6. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
7. Assists with credentialing audits; conducts internal file audits.
8. Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
9. Monitors the initial, reappointment and expirables process for all medical staff, Allied Health Professional staff, Other Health Professional staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures.
10. Performs miscellaneous job-related duties as assigned.
High school diploma or equivalent required.
Three (3) years experience in health care, managed health care, or related field.
This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
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