Credentialing and Contract Specialist

Job Description Summary
Provides administrative support to the SJH Medical Staff to contribute to the mission and goals of SJH as well as those outlined in the Medical Staff Bylaws, Rules & Regulations, DNV standards and other applicable Federal, State and local regulatory and/or accrediting agencies. Assumes primary responsibility for Medical Staff and other provider credentialing and meeting support. Delivers services according to the Scope of Service for Medical Staff Services. Adheres to the SJH Corporate Compliance Program and participates in performance improvement activities.

Essential Functions

1. Credentialing
• Coordinates the Medical Staff, preceptee, and other provider credentialing processes, including billing and collecting Medical Staff dues, to assist the Medical Staff in assuring all individuals with clinical privileges provide services only within the scope of their training/licensing.
• Ensures the confidential files on medical staff members are up to date, reflecting the current status of medical staff standing and all expiring documents (category, board certification, privileges, dues, CME activities, etc.)
• Distributes initial and reappointment applications as per policy and upon receipt initiates primary source verification of information. Reviews applications for completeness and compliance with applicable policies and the Medical Staff Bylaws.
• Assembles all primary source verification information and prepares credentials file summaries for presentation to the Credentials Committee, Medical Executive Committee, Joint Compliance & Quality Committee, and the Board of Trustees.
• Actively maintains, develops, and updates skills and specific knowledge to implement ideal service.

2. Administrative Duties
• Establishes and maintains good communication with the Medical Staff, hospital administration, nursing staff, preceptees, and all hospital personnel.
• Provides support services to the Director of Medical Staff and Medical Staff members as requested.
• Attends continuing education programs in the field of Medical Staff Services, and when certified, maintains certification through the National Association of Medical Staff Services.
• Maintains an up-to-date practitioner database, including appropriate documentation, in the MD-Staff credentialing software.
• Has a working knowledge of the Medical Staff Bylaws, Rules & Regulations, applicable hospital policies, state/federal legal requirements, and DNV Medical Staff standards to provide updated information when needed.

3. Medical Staff Meetings
• Prepare the agendas, notices, and meeting packets for Medical Staff meetings as assigned. Attend Medical Staff meetings to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in a professional and effective manner.
• Attend the Credentials Committee, Medical Executive Committee, and Quarterly Medical Staff meetings, to serve as a resource on credentialing and privileging matters. Available to coordinate media needs, record meeting minutes, document actions taken and track follow-up items in the absence of the Director of Medical Staff Services, when needed.

4. Additional Duties
• Work with Risk Management to aid in preparing and submitting SJH medical malpractice insurance applications to ensure continued coverage for employed, and some contracted, practitioners. Communicates effectively with the insurance carrier regarding policy initiation, renewal and any changes in coverage.
• Coordinate the dissemination of necessary information to the applicable hospital departments to ensure appropriate set-up of practitioners in the applicable hospital systems following approved changes by the Board of Trustees.
• Work with Hospital Administration staff to aid in the maintenance and updating of hospital contracts, when requested.

Job Requirements
Minimum Education
Required: Bachelor's degree or a minimum of one year experience that is directly related to the duties and responsibilities, as specified, or a High School diploma/GED with at least two years' experience that is directly related to the duties and responsibilities specified.

Preferred: Membership and yearly continuing education through the National Association Medical Staff Services. Experience in vetting, executing, and maintaining contracts.

Minimum Work Experience
Required: Two years of medical staff related experience, which may include administrative assistant responsibilities, proficiency in Microsoft Office Products, Acrobat X, and verbal/electronic communications.
Preferred: Experience with the hospital credentialing processes, medical staff credentialing software, and quality performance software. Previous experience working as a paralegal.

Required Licenses: Current NAMSS Certified Provider Credentialing Specialist (CPCS) certification. If not currently certified, must be actively seeking certification with the ability to become certified during the first testing cycle as soon as the minimum eligibility criteria outlined by NAMSS is met.

Functional Demands
Working Conditions

Hospital office setting in a close office space. Work and/or education outside the hospital with some travel when deemed appropriate. Possible stressful situations related to interpersonal nature of the issues addressed by Medical Staff Services.

Physical Requirements

80 to 90% of time spent sitting with 4 to 6 hours a day of computer use. Must be available for working hours outside normal business hours for meetings and/or travel on occasion, if necessary

Direct Reports: None

Reports to: Director Medical Staff Services

Internal & External Contacts
Medical staff, provider office and clinical support staff, preceptees/resident rotation coordinators, hiring managers, SJH staff, vendors, accreditation representatives.

Leadership Capabilities

Attention to Detail
• Completes tasks in a way that ensures documentation is as accurate and timely as possible
• Methodically and patiently reviews work to identify any mistakes or discrepancies
• Creates and stores documentation in a way that is thorough and easy to access

Initiative
• Doesn't wait for others to tell them what to do; sees a problem or opportunity and immediately starts moving to address it
• Finds their own motivation for completing work and accomplishing goals
• Willing to provide extra support assisting providers with initial, reappointment, and/or clinical privileging applications

Systems Thinking
• Take a broad perspective to understanding how things work
• Able to see the connections, interdependencies, and relationships between departments, strategy, people, and processes

Verbal and Written Communication
• Is able to write clearly and concisely in a variety of communication settings and styles in order to draft messages that communicate significance
• Can communicate verbally to successfully provide information to providers, internal and external contacts with the desired effect and appropriate importance

Approachability
• Is easy to approach and talk to
• Spends extra effort to put others at ease
• Builds rapport with providers, internal and external contacts well

---