Health System Specialist

3 weeks ago

Fairfield, United States Veterans Health Administration Full time

The Credentialing & Privileging Specialist ensures compliance with VHA policies, directives, memos and notices of The Joint Commission (TJC) standards, recommendations by the Office of Inspector General (OIG) and Government Accountability Office (GAO) and other internal or external auditors and reviewers as appropriate. The incumbent is responsible for collecting relevant data and making informed decisions to ensure qualified health care professionals are providing appropriate care in appropriate settings. The incumbent is the subject matter expert (SME) to LIPs and Service Chiefs regarding routine and complex matters related to C&P including provider competence for the ongoing provider practice evaluation (OPPE) and focused provider practice evaluation (FPPE). The functions of the Medical Staff Office are critical to patient safety and for assuring the quality of patient care provided by the VAMC.

Major duties include, but are not limited to:
Assists the C&P Manager/Analyst in developing short- and long-term goals necessary to accomplish the mission of the C&P program.
Assists in identifying the resources necessary for accomplishing the mission and function of the credentials and privileging program.
Receives and reviews VetPro reports detecting problem areas requiring further investigation. Upon identification of a problem, researches reference materials, regulations, and standards to identify appropriate action necessary to correct the problem.
Ensures accurate provider data is entered into and maintained in the VetPro computer program. Informs C&P Manager/Analyst of trends identified, audit results and identified problems that may affect a provider's privilege status.
Manages provider applications (initial and renewals) for LIPs C&P within the VAMC.
Provides guidance and instruction to hospital staff in completing the required documentation of establishing privileges for LIPs. Upon receipt of individual credentials' files for review, incumbent ensures primary source verification to include, but not limited to, state licenses, DEA license, certifications, medical specialty training, and board certifications.
Assures application packages and other documents meet technical requirements per specialty of provider and assures application folder and database account (VetPro or other internal databases and spreadsheets) meet technical requirements.
Prepares agendas for credentials related meetings, ensures those involved are notified of expectations, and ensures appropriate paperwork is accomplished completely and accurately prepared for committee action.
Conducts final appointment into the VetPro database, after thoroughly researching, analyzing and validating all data, information, documents and signature authorities.
Composes correspondence requiring Clinical Service Chiefs, Chief of Staff and Medical Center Director signatures for privileging actions.
Establishes and maintains a variety of files and records pertaining to the C&P process.
Holds the credit card and is responsible for maintaining records, reconciling monthly charge statements and verifying legitimacy of requests for NPDB CQ enrollments/ renewals, licensure verification (if applicable), Educational Commission for Foreign Medical Graduates , American Medical Association, FSMB, National Student Clearing House, Work Number and, board certification (if applicable). Initiates electronic requests and bank checks for payment of fees according to standard operating procedures as needed.



Work Schedule:
Monday through Friday 8:00 Am to 4:30 PM


Telework:
Not available


Virtual:
This is not a virtual position.


Position Description/PD#: Health System Specialist (Credentialing and Privileging Specialist)/
PD99876S


Relocation/Recruitment Incentives:
Not authorized


Financial Disclosure Report:
Not required

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