GENERAL PURPOSE:Participates in the most complex departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Audits, measures performance, trains team, serves as a resource of the department, and collaborates with management to advance the quality of practitioners and patient safety of the facility. Assists with Credentialing Administrator duties including coordination and review of department activities.JOB DUTIES AND RESPONSIBILITIES:
Audits Credentialing application/files for Completion and Accuracy: Audits/analyzes and monitors the credentialing application/files processed by Credentialing Specialist staff to ensure appointments are processed in required timeframes, includes all required primary source verifications and accompanying documentation to ensure files meet regulatory requirements.
Performance Management and Training: Documents and tracks performance statistics of the Credentialing Specialists application processing related to accuracy and communicates with the managers when issues are identified. Reviews statistics regarding performance measures and goals with management regularly and assist with identifying trends. Trains new and existing staff on how to process initial and/or reappointment/re-credentialing applications.
Initial Credentialing, Re-credentialing and Credentialing Changes: Determines practitioner eligibility for membership/participation or changes in status. Analyzes the application and supporting documents for accurateness and 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.
Final Review and Approval Process for Completed Credentials files: Reviews file for accuracy and completeness before submission. Electronically routes the credentials files to the department chief/chair or designee for review and recommendation for membership and privileges for Strong Memorial Hospital and Highland Hospital. Coordinates the weekly expedited credentials committee and board approval process for credentials files being recommended by the departments for Strong Memorial Hospital and Highland Hospital. Coordinates emergency privilege requests for hospital privileges as needed for all UR affiliates. Prepares practitioners credentials files for presentation to affiliate and non-affiliate CVO clients and coordinates the electronic routing through the credentialing software or other secure electronic process.
Liaison and Leadership Support: Assists the Credentialing Coordinator with the Enrollment of Liability insurance for qualified practitioners as needed. Assists the Credentialing Coordinator with the National Practitioner Data Bank Continuous Query Renewals. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. 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 to assure deadlines are met. Assists management with review and assessment of departmental functions and services to identify areas in need of review or improvement and implement changes as needed. Assists the Credentialing Coordinator and management with Telehealth Activities. Assists with various aspects of the credentialing expirables process including and not limited to the ongoing monitoring of sanctions, board certification status and current malpractice coverage. Represents of the Medical Staff Services Department for various initiatives, audits and/or committee meetings as needed. Serves as the primary back up to all credentialing staff including the Credentialing Coordinator. Serves as a Team Peer Interviewer as needed.
Other duties as assignedQUALIFICATIONS:Associate's Degree in business or healthcare related field required. 1 year of experience in Medical Staff credentialing and/or payer enrollment functions required or equivalent combination of education and experience. Required knowledge, skills and abilities: Fluent English language skills (oral and written); 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. 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/DisabledPay RangePay Range: $23.00 - $32.29 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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