Job Description
We are currently looking for a Full Time Credentialing Specialist to join our Clinician Services team located at the Chickasaw Nation Medical Center.
Summary: Oversees for all functions related to coordinating, auditing, and monitoring the review and approval process for credentialing and recredentialing and for maintaining the appointment and reappointment files of the medical staff.
Responsibilities: * Processes applications for appointment and reappointment by gathering the required data and performing primary source verification utilizing the credentialing software, on-line services, and any manual process within the required and specified time periods according to established policies and procedures
* Reviews privilege requests and any required documentation
* Requests assistance from the Manager when unclear about request and/or documentation received
* Responds to requests for application for medical staff membership and privileges
* Verifies licensure, education, training, and other requirements in accordance with policies and procedures
* Reviews completed file for accuracy and identifies problem areas, issues, concerns, or new information that is to be brought to the attention of Manager
* Assists with policy and procedure reviews and updates
* Performs routine programmatic/department reports and updates and provides consistent, timely communication as necessary
* Upholds minimum necessary regulations when accessing provider files and with disclosing confidential information
* Maintains strict confidentiality of all provider information and any information always disclosed at credentialing committee
* Keeps credentials files organized, accurate, and up to date
* Identifies and obtains current verification of expirable data elements
* Maintains database management of demographic information on providers and tracking/updating of expired information to assure accurate and current data exists for each provider maintained in the credentialing database
* Inputs all relevant data into medical staff e-files and credentialing database in a timely and accurate manner
* Prepares Credentialing Committee report and previous committee minutes for review by Manager and Committee Chair
* Assists with coordination of Credentialing Committee as requested by the Manager
* Performs all follow up required following Governing Board decision, i.e., letters to providers, electronic or other notifications to medical staff, data entry, credentials file organization
* Prepares files and any required documents to accompany files/requests to Credentials Committee, Medical Executive Committee and Governing Board
* Provides first class customer service - courteous and helpful to all internal and external customer types
- Answers questions in a courteous and professional manner
- Greets and engages with a smile
- Determines needs, seeks positive experience and outcomes
* Completes all training and development requirements and participates in continuing education opportunities
* Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains general upkeep of work area and maintains a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
* Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
* Performs all other duties as assigned
Competencies: Essential:
* Ability to communicate effectively (via email, on the phone, and etc.
* Ability to work with a team of individuals, managers, etc. to develop strategies, ideas, initiatives, and/or processes, etc.
* Able to follow instructions, both written and oral
* Able to adhere to all scheduling and attendance requirements
* Ability to portray a positive image to guests
* Must be detail-oriented
* Must be self-motivated
* Honesty, truthfulness, reliability, accountability
* Prioritizes, meets deadlines and works independently in a high-pressure environment and uses appropriate judgement in upward communication regarding assignments
* Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
* Possess basic knowledge of medical terminology
* Knowledge of current medical standards as related to the Joint Commission, hospital credentialing and privileging process
* Ability to multitask
* Organizational and time-management
* Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
Skills: Essential:
* Proficient with Adobe Acrobat suite of products
* Possess strong skills in modern office procedure and business etiquette
* Intermediate computer skills
* Intermediate skill using Microsoft Office products
* Accurate typing and/or data entry skills
Experience: Essential:
* 4 years directly related experience
Education: Essential:
* Associates Degree in directly related field
Nonessential:
* Bachelors Degree in directly related field
Credentials: Essential:
* Pass general background check
* Cert Provider Credentialing Specialist
Essential:
* Wiliness to obtain CPCS within 3-5 years of hire if not currently certified.
Working Conditions: Essential:
* Works in an office setting
* Stressful environment due to any or a combination of deadlines, pressures, multiple tasks, lines of communication, risks, speed of operations, etc.
* Visual acuity for detail, distance, color, depth perception
* Sitting up to 100% of shift
* Standing up to 25% of shift
* Walking up to 25% of shift
* Infrequent travel
* Pass pre-employment drug test
Job Tags
Full time, Work at office, Shift work,