JOB SUMMARY:

The Medical Staff Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statute and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database systems and related applications.

ESSENTIAL FUNCTIONS, 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 the Livingston HealthCare Medical Staff Committees, ensuring the timely completion..
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 managed care delegated credentialing audits; conducts internal file audits.
8. Utilizes the MD-Staff credentialing database, optimizing efficiency, and performs query, report and document generations, submits and retrieves National Practitioner Database reports in accordance with the 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, and delegated providers ensuring compliance with regulatory bodies, Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
10. Oversees credit cards and statements.

ADDITIONAL RESPONSIBILITIES:

1. Prepares various documents in accordance with the organizations rules and procedures.
2. Assists in compiling financial, statistical data and reports as assigned.
3. Performs miscellaneous job-related duties as required.

OTHER FUNCTIONS, DUTIES AND RESPONSIBILITIES OF ALL EMPLOYEES:

1. Supports and models individual behavior consistent with the mission, vision and values of Livingston HealthCare.
2. Demonstrates commitment to customer service by:

• • Building effective working relationships and treating others with respect
  • Interacting with customers (patients, co-workers and visitors) in a warm and friendly way
  • Taking immediate action to meet customers’ needs or requests
  • Attentive to each customer concern

3. Demonstrates and encourages an ethic of open and effective communication and teamwork throughout the organization.
4. Adheres to Livingston HealthCare’s Code of Conduct, Standards of Excellence, Livingston HealthCare policies, and departmental compliance policies.     

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements which may be inherent in the position.

WORKING CONDITIONS:

Physical Demands

While performing the duties of this job, the employee is regularly required to sit and use hands for writing, adding machine, computer keyboard, and using telephone. The employee is occasionally required to reach with hands and arms and stoop or kneel.

The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.        

1. Position is performed in an office setting.
2. Noise level is usually moderate.
3. Is subject to frequent interruptions.

QUALIFICATIONS (Required):

1. High school diploma or equivalent (GED) with at least three (3) years directly related to hospital medical staff of managed care credentialing.
2. Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing certification with the ability to become certified within one (1) year from the date of hire.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

1. Ability to communicate effectively, both orally and in writing.
2. Program planning and implementation skills.
3. Knowledge of related accreditation and certification requirements.
4. Knowledge of medical credentialing and privileging procedures and standards.
5. Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
6. Working knowledge of clinical and/or hospital operations and procedures.
7. Informational research skills.
8. Ability to use independent judgment to manage and impart confidential information.
9. Database management skills including querying, reporting, and document generation.
10. Ability to make administrative/procedural decisions and judgment.