This position is responsible for all credentialing and re-credentialing audits with managed care organizations. Responsibilities include keeping current on all NCQA standards and preparing policies regarding these standards. In addition, this position is responsible for hospital credentialing for non-board approved providers.
Provides direction and suggestions to the Medical Staff Coordinators for the operational process of credentialing delegated providers. Feedback is also provided for improving the process and informing individuals when the delegated credentialing process is not completed as expected.
Manages data integrity and accuracy for delegated credentialing information. Works with various entities or departments to ensure information is complete and up to date. Maintains all providers' credentialing information including data tables that populate provider credentialing information.
Develops new processes for delegated credentialing physicians and advanced practice professionals. Participates in training and development of the departmental software system.
Responsible for credentialing locum providers, proctored physicians and supervised clinical providers.
Manages and generates regular and ad-hoc credentialing and statistical reports. Assures correctness and integrity of reports distributed to the UF Health system and managed care plans and provider service network affiliates are correct and accurate, including information to be printed in directories.
Acts as a system-wide subject matter expert.
Works closely with the Managed Care Department as simultaneous users of the database to ensure changes to the structure of the database and appropriate fields are set up and utilized to meet both departments' objectives.
Initiates and manages performance improvement projects for the Medical Staff department.
Attends meetings and quality improvement activities as required, accountable for information presented.
Meets training requirements as expected with minimal follow-through required.
Supports all customer service goals and programs.
Adheres to dress code, mission statement, policies and procedures and time and attendance guidelines.
Maintains patient confidentiality and acts in an ethical manner at all times. Ensures adherence.
Performs all other duties as assigned by management within job specifications.
Required Education: Bachelor's Degree. Ten (10) + years relevant experience and NAMSS certification (CPCS or CPMSM) may be accepted in lieu of a degree.
Preferred Education: Bachelor's in Health Care Administration, Business Administration or other related field.
1. Demonstrated use and knowledge of complex database applications. 2. Excellent written and verbal communication skills. 3. Ability to work with people across many different departments in the organization, as well as internal teams. 4. Ability to work with people of varying levels of skill sets and to utilize those skill sets. 5. Ability to interact appropriately with front-line employees, managers, directors and executives. 6. Ability to be an effective trainer. 7. Must have knowledge (or ability to comprehend) accreditation standards
Required Licensure/Certifications: Certified Provider Credentialing Specialist (CPCS) OR Certified Professional Medical Services Management (CPMSM) by the National Association of Medical Staff Services within two (2) years of date of hire or transfer into position.
Required Experience: 1-2 years Medical staff services/credentialing, healthcare, human resources in a healthcare environment or related field OR Crystal report writing experience.
Preferred Experience: Experience with hospital quality process improvement.
UF Health Jacksonville is a private, not-for-profit hospital affiliated with the University of Florida Health Science Center campuses in Jacksonville and Gainesville. Combining our strengths with the UF College of Medicine – Jacksonville, we offer residents in northeast Florida and southeast Georgia all the benefits of an academic health center. The hospital is made up of more than 3,300 employees, all supporting the hospital's mission to heal, to comfort, to educate and to discover through quality health care, elimination of health disparities, medical education, innovation and research in an environment where exemplary medical care is complemented by outstanding service.
As an academic health center, we're on the leading edge of the latest treatments and technologies. And our participation in clinical trials brings the latest research advances to the clinical setting, pioneering medical advances today to benefit patients tomorrow. Our knowledge and expertise are unmatched—the UF faculty physicians who practice here teach and train other physicians in the latest medical practices.