CREDENTIALS COORDINATOR, Full-Time, Mon-Fri 8a-4:30p

Job Summary: Responsible for all functions related to coordinating, auditing and monitoring of the approval process for credentialing and recredentialing, and the clinical privileging of the medical staff and delineation of services for the allied health professionals for the hospital. Performs coordination of all HIM clerical functions, encompassing release of protected health information for all requestors, birth certificate completion, scanning and indexing of discharged medical records, discharge analysis and reporting of incomplete or delinquent medical records

Demonstrates Competency in the Following Areas:

Coordinates the processing of applications. Assures all applications are processed completely and in a timely manner and maintains the credential files. Answers correspondence regarding credentials.

Ensures that all CRNA and contract physicians display association with the hospital through Medicare, Medicaid, and Arkansas Blue Cross to ensure timely billing for services rendered.

Assists and provides support to the Credentialing Committee in assuring that all individuals credentialed and/or granted clinical privileges are qualified to provide patient care, treatment and services based upon the scope of their training, licensure and experience.

Knowledge of medical staff bylaws, medical staff rules and regulations, as well as accrediting organization standards, Center for Medicare and Medicaid Services (CMS) regulations, state regulations and other regulatory agencies as they pertain to medical staff and allied health professionals.

Audits applications, reviews supporting documents, including all primary source verification for all credentialing and recredentialing to ensure medical staff and allied health professional files are current and policies and procedures have been followed to obtain required documentation and verification.

Oversees and assists with the preparation of agendas, research and candidate credentials files for Credentialing Committee and provides support to medical staff department and committee meetings. Responsible for follow-up action required, including composition of correspondence for chiefs/ chairpersons, as well as distribution of materials.

Maintains and monitors confidential information for quality/peer review discussion and other sensitive matters.

Responsible for assuring that the findings, conclusions and recommendations for actions to appoint or reappointment applicants and/or improve the credentialing program are reported through appropriate medical staff committees, or appropriate leadership, and that approved actions are then assigned and/or implemented in a timely manner.

Serves as information resource in credentialing to both medical staff and allied health professionals.

Monitors and makes recommendations for credentialing and privileging forms as needed. Oversees ongoing development and revisions of delineation of privileges utilizing heavy physician input and physician committee approval. Responsible for overseeing the development of new privilege criteria.

Responsible for overseeing the development of new privilege criteria.

Maintains physician database in the EMR, adding newly credentialed and outside clinicians.

Assists in troubleshooting any stem issues related to scanning or any other applications utilized by the clerical staff.

Possesses working knowledge of state and federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and accrediting organization standards.

Coordinates the release of information process and assists requestors with access to and release of protected health information (PHI) in adherence with state and federal requirements

Ensures discharged records are retrieved from the units in a timely manner in order to facilitate timely scanning

Oversees the scanning and indexing of health and administrative information into the hospital’s electronic health record system.

Analyzes medical records of discharged patients for completeness and accuracy according to department and hospital policy and procedures and enters deficiencies into computer for physician completion.

Ensures birth certificates are completed within 24 hours of birth or admission whenever possible and files certificates with local registrar within 10 days of completion.

Assists parents(s) of children born in the hospital by completing any forms/statements needed to correct birth certificate errors.

Maintains statistics on all births and submits statistics and makes them available for reporting purposes.

Ensures birth certificate completion accuracy is within 95% compliance or greater.

Submits birth, Fetal death certificates and PKU laboratory testing to the Arkansas Department of Health

Scans pathology reports so they are available for review by the contracted Tumor Registrar.

On a monthly basis sends all paternity affidavits filed on newborns for the previous month to the Department of Child Support Enforcement.

Assists the Director of HIM in notifying clinicians and hospital administration as needed in the distribution and reporting of incomplete/delinquent medical records

Works with staff to ensure all functions within the clerical area, e.g. scanning, release of information and discharge analysis are completed within assigned timeframes and meet 95% accuracy.

Trains staff and ensures proper phone/customer service etiquette is followed.

Acts as clinician liaison regarding record completion or any other clerical function within HIM.

Maintains a solid working relationship within HIM and all other Departments.

Performs staff quality audits of all HIM clerical functions and provides feedback to staff on areas warranting improvement. Ongoing quality issues are referred to the Director of HIM to initiate a performance improvement plan if warranted.

Acts as a backup for all clerical functions and performs other duties as assigned by the Director of HIM.

Completes both hospital annual education requirements as well as requirements to meet medical staff services credential requirements from NAMSS

Represents the organization in a positive and professional manner, both internally and externally.

Supports and maintains a culture of safety and quality.

Maintains patient confidentiality at all times.

Professional Requirements:

Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the Medical Staff Services Department by belonging to professional organizations, attending seminars, and reading journals and publications addressing medical staff activities and maintenance of any certifications, e.g. CPMSM.

Adheres to dress code, appearance is neat and clean.

Actively participates in performance improvement and continuous quality improvement (CQI) activities.

Complies with all organizational policies regarding ethical business practices.

Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department.

Regulatory Requirements:

· High School graduate or equivalent.

· Two (2) years of experience in hospital and/or healthcare credentialing.

· Medical Staff Services certification:

· Certified Professional Medical Services Management (CPMSM) or

· Certified Provider Credentialing Specialist (CPCS) or

· Education plan to obtain in 12 months

Language Skills:

· Able to communicate effectively in English, both verbally and in writing.

· Excellent interpersonal skills.

Skills:

· Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.

· Advanced computer skills in word processing, spread sheets and databases.

· Excellent organizational skills.

Physical Demands:

· Normal hospital environment. Close eye work. Hearing within normal range. Oral communication. Operated computer, copier, printer. Frequent sitting. Occasional walking, bending, climbing. May lift and carry up to 15 pounds. May push/pull up to 50 pounds.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.