New York State, New York
Durham, North Carolina
Posted: 15-Mar-23
Location: Jacksonville, Florida
Type: Full Time
Categories:
Sector:
Required Education:
Internal Number: 95758
Summary:
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.
Necessary Skills:
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.
