Med Staff/Credentialing Spec

2 months ago

Ann Arbor, Michigan, United States University of Michigan Health System Full time
Summary

Provides a full range of professional services for credentialing, recredentialing, processing applications and verifying licensing and certifications, monitoring sanctions, assessing competency, and processing privileging, as appropriate by applying expert knowledge, expertise, and experience. Acting as a specialist in the complex Michigan Medicine credentialing process, has the authority to make independent decisions on matters of significance within the scope of responsibilities through analyzing, comparing. and evaluating various courses of action.

This is a hybrid position, after a 4-6 week on-site training period, the expectation is on-site 2-days per week.

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?
  • Excellent medical, dental and vision coverage effective on your very first day
  • 2:1 Match on retirement savings
Responsibilities*

Accountability for completion of initial appointment/reappointment, credentialing, and privileging following strict requirements of Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), the National Committee for Quality Assurance (NCQA), Healthcare Facilities Accreditation Program (HFAP), and Utilization Review and Accreditation Commission/American Accreditation Health Care Commission (URAC) to ensure the safety of our patients and safeguard Michigan Medicine against loss of accreditation, malpractice claims, and claims of negligent credentialing.
  • Identifies red flags during the credentialing and privileging process. with authority to halt the process until the issue has been resolved, and is empowered, using strong analytical skills and judgment, to resolve locally or determine if the issue should be escalated. The credentialing specialist autonomously conducts the final analysis meticulously before deeming the credentialing packet as complete and ready for committee review and Board approval.
  • Conducts all primary source verification necessary to complete the credentialing and privileging process maintaining standards in accordance with policies, procedures. rules, regulations, and accreditation requirements. Through delegated credentialing contracts, the credentialing specialist completes this work on behalf of each contracted plan, leveraging the contracts to expedite enrollment and reimbursement.
  • Using expert knowledge, creativity, and ingenuity, identifies and implements ideas for process improvement using LEAN tools and strategies, wherever possible, keeping within the confines of the rules, regulations, and accreditation requirements to develop a more efficient process while still providing a safeguard to the institution.
  • Applies broad knowledge and ability in interpretation and dissemination of policies, procedures, and process/rules/regulations/law changes, with regard to credentialing and recredentialing for practitioners at Michigan Medicine. Will act in an advisory capacity when questions or concerns on policies and procedures are raised.
  • Ensure regulatory and accreditation agencies readiness with contracted health plans, triennial and biennial Joint Commission surveys for both routine and disease specific certifications, ad hoc CMS, and Stale of Michigan surveys, by analyzing credentialing records to affirm all requirements are met. Maintains the confidentiality of credential information, exercising due caution and discretion in responding to inquiries for information.
  • Maintains and protects the integrity of the credentialing database as the source of truth for privileged provider information throughout the health system's various IT systems such as the electronic health record, online provider directory, and billing system. Ensures database accuracy so that Provider Enrollment can complete health plan enrollment.
Management and maintenance of expirables such as license, certification, and other credentials to maintain compliance with State law, policies, and procedures. Perform credentialing file audits to assure compliance with internal credentialing standards.
  • Clearly and accurately presents complicated and exacting information regarding credentialing, recredentialing, and privileging to the clinical departments, providers, and institutional stakeholders.
  • Responds to inquiries and complaints regarding matters of a sensitive or confidential nature, exercising initiative, independent judgment, and diplomacy, with an excellent customer service-oriented attitude.
  • Represent Michigan Medicine and MSS in local, state, and national Medical Staff Services organizations.
  • Other duties as assigned.
Required Qualifications*
  • Bachelor's degree or equivalent combination of education and experience.
  • Knowledge of accreditation and regulatory requirements for credentialing and privileging.
  • 1-2 years experience as a credentialing specialist or credentialing coordinator.
  • LEAN training or complete LEAN training within 3 months of hire.
  • Demonstrated excellent interpersonal, problem-solving and communication skills, both written and oral.
  • Ability to make independent decision on matters of significance using analytical skills and sound judgment
  • Excellent organizational and multi-tasking skills.
  • Ability to work effectively, cooperatively, and professionally with a diverse group of faculty and staff, and aid in the training and education of all existing and new staff.
  • Accurate and detail oriented, along with the ability to handle multiple tasks and priorities simultaneously with numerous interruptions.
  • Must be able work under pressure in a fast-pasted environment, with strong time management skills.
  • Demonstrated ability to work independently with a positive attitude.
Desired Qualifications*
  • 3-5 years of credentialing and privileging experience.
  • Experience with CACTUS by symplr credentialing software.
  • CPCS certification.
  • Extensive knowledge of credentialing and privileging, as well as the Michigan Medicine hiring process.
  • Knowledge of Hospital or clinical department policies and procedures.
Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.

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