Under the direction of the Department Manager, performs a wide variety of complex duties related to the hospital credentialing processes necessary for initial appointment and reappointment in accordance with the Joint Commission standards and other State and Federal regulatory agencies to ensure compliance with licensing and accreditation requirements.
Duties and Responsibilities:
- Responsible for conducting the physician/practitioner initial appointment and reappointment process for the Hospital in accordance with The Joint Commission standards and other State and Federal Regulatory agencies
- Responsible for ensuring compliance with licensing and accrediting agency requirements
- Responsible for conducting all credentialing functions in collaboration with other department employees to include intake, primary source verification, documentation and tracking of physician/practitioner initial applications and reappointment applications
- Validates provider applications for completeness, accuracy and appropriate signatures and necessary releases prior to processing
- Utilizes independent judgment in determining the completeness of information prior to processing applications/reapplications and ensures accurate input of information from applications into the Medical Staff Department's computer software database for processing
- Maintains written and verbal correspondence with applicants and references regarding status of the applications/reapplications and provides appropriate follow up in deficient areas in the application
- Provides necessary assistance in planning meetings, developing agendas, preparation of committee reports, and maintenance of credentials records
- Maintains and processes written and verbal correspondence with Federal, State and local agencies, hospitals, medical review and licensing boards and liability carriers regarding insurance status and claims histories through electronic inquiries or via hard copy
- Assists with the maintenance of the policy and procedure manuals as they relate to the credentialing process
- Assists other employees in the Department involved in the credentialing process as required.
- Reviews and determines whether applications/reapplications qualify for standard or expressing processing utilizing Medical Staff approved criteria and coordinates the processing of those applications with respective department chairs, the Chair or designee of the Credentials Committee and Board subcommittee members
- Acts as a representative for AVH at external meetings, committees, and special events as assigned by the Department Manager
- Notifies appropriate hospital personnel of new appointments/resignations from the Medical Staff and Allied Health Professional staff
- Maintains applicant profiles for Medical Staff members and Allied Health Professionals to enable proper review through the Medical Staff structure
- Provides clerical support for additional Medical Staff committees when requested
- Other duties as assigned
Knowledge, Skills and Abilities:
- Knowledge of verification sources for credentialing processing
- Knowledge of English usage, spelling, grammar, and punctuation
- Knowledge of Hospital credentialing requirements
- Knowledge of records retention requirements in relation to Medical Staff documentation
- Must have knowledge of medical terminology or ability to successfully complete a course in same
- Knowledge of the application and reappointment processes
- Must possess a solid understanding of privileging principles
- Knowledge of regulatory requirements for credentialing and privileging
- Knowledge of medical staff services principles, methods and procedures
- MS Office skills
- Credentialing software skills (HealthStream Echo experience preferred)
- Internet research skills
- Telephone etiquette skills
- Strong interpersonal and customer service skills
- Ability to independently research accreditation and regulatory publications
- Ability to provide a high degree of accuracy
- Ability to exercise independent judgment, with latitude for independent initiative based on technical expertise
- Ability to expand on own initiative in performance of duties
- Ability to plan, organize and control workflow
- Ability to complete duties with dependability and reliability
- Ability to learn and expand skills
- Ability to communicate with tact and professionalism
- Ability to manage stressful situations
- Ability to think critically and solve problems/issues
- Ability to resolve conflict
- Ability to adapt to changes in processes
Core Competencies: All AVH employees will effectively demonstrate these behaviors:
Ethics & Values
Integrity & Trust
Education and Experience:
- High school diploma or equivalent required.
- Associate's degree preferred.
- 1-4 years of hospital credentialing experience or equivalent related experience
- Clinical experience preferred
Required Licensure and/or Certifications:
- NAMSS (National Association Medical Staff Services) certification in credentialing (CPCS Certification) preferred
Physical Requirements and Working Conditions:
(Please reference key physical and working conditions)
- Primarily works in a climate-controlled area
- Sitting 80% of time on duty
- Tolerate repetitive arm and hand movements and viewing of computer monitor display
- Able to lift up to 10 lbs, occasionally up to 25lbs.
A detailed description of the physical requirements of this job is maintained in the Employee Health Department.
Looking for an opportunity to work in healthcare the way you always dreamed you could? At Antelope Valley Hospital, our employees are at the heart of what we do best – delivering high quality, patient-centered healthcare.
Antelope Valley Hospital, a 420 bed acute care facility, located just 60 miles north of Los Angeles, the Antelope Valley is one of Southern California’s fastest growing communities. We are a Level II Trauma Center and Joint Commission Primary Stroke Center Accredited. Serving the community for over 50 years, our non-profit hospital has grown to be the preeminent healthcare facility for our district’s nearly 1.2 million residents.
An Equal Opportunity Employer.
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