GENERAL PURPOSE:Participates in departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Serves as a resource of the department, and collaborates with other team members to advance the quality of practitioners and patient safety of the facility.JOB DUTIES AND RESPONSIBILITIES:
Conducts Initial Credentialing and/or Re-credentialing of Eligible Practitioners: Determines practitioner eligibility for membership/participation. Analyzes the application and supporting documents for accurateness add completeness and informs the practitioner of the application status, including the need for any additional information or corrections. Obtains, researches and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards in order to validate the accuracy of applications for one or more decision making bodies. This includes a thorough background investigation and primary source verification of all components of the application file and not limited to the applicants education and training, licensure, work history, hospital affiliation history, malpractice claims history, board certification status, criminal background, evaluation of health status and peer recommendations. Recognizes, investigates and validates discrepancies and adverse information obtained during the application process to ensure that review and approval bodies have information needed to make informed credentialing decisions. Processes requests for privileges when applicable, ensuring compliance with criteria outlined in clinical privilege descriptions.
Timelines and Statistics: Monitors the initial and reappointment process for all Medical and Allied Health Professional staff as needed to ensure appointments are processed in the requested or required timeframes and meet regulatory requirements including all required primary source verifications and other documentation. Monitors the status of completed files that are in departmental review and/or committee review until final approval to ensure compliance with regulatory standards. Monitors personal performance statistics related to accuracy and productivity and communicates with the managers when questions or concerns arise or when additional training is needed. Reviews performance measures and goals with Auditors and Management regularly. Ongoing collaborations and coordinations of activities with the Credentialing Managers and staff.
Liaison: Collaborates with various departments and key stakeholders to ensure all policies and standards are met including and not limited to the Compliance office, Dean's office, Health office and Legal office. Communicates the status of the applicant files directly to providers and various department representatives, clients and/or affiliates and coordinates efforts to obtain necessary information and/or documentation related to the practitioner's appointment and to assure deadlines are met. Communicates the status of expiring credentials such as license, DEA, health reviews, PPD, infection control, specialty privilege requirements, etc. directly to providers and various department representatives and/or outside organizations, clients or affiliates and coordinates efforts to obtain necessary information and/or documentation to assure deadlines are met. Serves as a resource for departments and clients pertaining to medical staff bylaw, policies and procedures. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
Projects/Initiatives: In collaboration with management, reviews and assesses departmental functions and services to identify areas in need of improvement and implement changes as needed. Assists with various aspects of the credentialing expirables process including and not limited to annual health requirements, license, DEA, malpractice coverage and board certification status. Represents the Medical Staff Services Department for various initiatives and/or committee meeting as needed. Serves as back up to other credentialing staff as needed. Serves as a Team Peer Interviewer as needed.
Other duties as assigned.QUALIFICATIONS:
Associate's Degree in business or healthcare related field required.
2 years medical administrative experience required or equivalent combination of education and experience;
1 year of medical credentialing and/or payer enrollment preferred.
Fluent English language skills (oral and written);
Proficiency in MS Office (e.g. Word, Excel, and PowerPoint), email, internet.
Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing;
Exceptional interpersonal and communication skills;
Ability to develop and maintain relationships with a variety of key stakeholders across the organization;
Knowledge of and experience with database applications.
Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) preferred.
The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.How To ApplyAll applicants must apply online.EOE Minorities/Females/Protected Veterans/DisabledHow To ApplyAll applicants must apply online.EOE Minorities/Females/Protected Veterans/DisabledPay RangePay Range: $21.36 - $29.90 HourlyThe referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.Apply for Job
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Location: Medical Faculty Group
Full/Part Time: Full-Time
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