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Medical Staff Coordinator - Centralized Credentialing

Company: Providence Health & Services
Location: Santa Rosa
Posted on: August 5, 2022

Job Description:

We are looking for a Medical Staff Coordinator for the NCR Centralized Credentialing Department at Santa Rosa Memorial Hospital. Location: Santa Rosa, CA Work Schedule: Full time - 80 Biweekly Hours Shift: 8-hour, Days Job Summary: Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Hospital. Responsible for ensuring providers are credentialed, appointed and privileged with health plans and hospital facilities. Maintains up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Responsible for preparation of medical staff meeting agendas, minutes, and follow-up correspondences. Works closely with contract credentials verification for appointment and reappointment of medical staff. Completes routine correspondences relative to verification of the medical staff status. Essential Functions:

  • Maintains knowledge of, and compliance with The Joint Commission standards pertaining to Medical Staff.
  • Maintains knowledge of, and compliance with, CMA Medical Staff Guidelines.
  • Maintains knowledge of, and compliance with, Medical Staff Bylaws, Rules and Regulations.
  • Coordinates and attends Medical Staff department/Service/Committee/general staff meetings.
  • Accurately completes credentialing, appointments and reappointment applications to be sent to payers and facilities on behalf of providers.
  • Tracks progress of outstanding applications and address issues as they arise.
  • Keeps current provider records electronically in credentialing software, electronic provider folders and in provider hard copy folders.
  • Tracks license and certification expirations, and DEA and professional liability expirations for all providers to ensure timely renewals.
  • Obtains needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc.
  • Prepares professional communication to providers, payers and facilities.
  • Works closely with the external Medicare/Medicaid provider enrollment entities to discuss specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting document and regulations.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Audits health plan directories for current and accurate provider information.
  • Prepares follow-up correspondences with practitioners following credential actions.
  • Maintains confidentiality of Medical Staff credential files.
  • Completes payer credentialing process including requesting enrollment/contracting with health plans; completing the plans credentialing/enrollment application; submitting copies of licenses, insurance, and other documents; facilitating signing the contract; and any other steps that may be unique to the carrier.
  • Prepares calendar, maintains credits and prepares annual report.
  • Coordinates appointments/reappointments with contract credentialing organization.
  • Participates in budget process.
  • Collaborates with medical staff and Hospital in developing and achieving goals.
  • Makes sound decisions within range of expectation for the job; promotes positive guest/staff relations.
  • Creates an environment that enables the Hospital to fulfill its mission and meet/exceed its goals.
  • Demonstrates the ability to work on multiple tasks and set priorities.
  • Uses good judgment and discretion regarding confidentiality of sensitive issues.
  • Maintains knowledge of current and new developments in the field of medical staff services and credentialing through attendance at professional meetings and reading journals in the field.
  • Maintains and keeps current the physician contracts and agreements. (Timesheets, check requests).
  • Maintains physician agreements for contracted services, on-call, medical directorship and prepares check requests for the same on a monthly basis.
  • Performs other duties as assigned to support the department's objectives. Skills:
    • Ability to record meetings using shorthand or other note-taking skills.
    • Working knowledge of regulatory requirements (Title 22 and JC).
    • Knowledge of the development of and adherence to Governance bylaws, Department rules and regulations and Policies pertaining to medical staff, practitioner/provider and the organization.
    • Knowledge of 3rd party payer credentialing requirements.
    • Knowledge of Medicare/Medicaid provider enrollment.
    • Strong interpersonal skills.
    • Excellent verbal and written communication skills including customer service skills.
    • Expertise in using all Microsoft Office products including Excel, word processing, data base management and graphic presentations. Strong, accurate typing skills.
    • A team player, adaptive and collaborative while working across the organization.
    • Demonstrates good judgment and discretion regarding confidentiality of sensitive issues.
    • Ability to work and thrive under pressure while handling multiple priorities and meet deadlines.
    • Critical thinking skills.
    • Analytical Skills.
    • Ability to work strategically. Minimum Position Requirements: Education: Bachelor's Degree or any combination of education and experience that would provide the required knowledge, skills and abilities. Experience:
      • 2 years Credentialing experience in a hospital or physician environment.
      • Demonstrated experience with managed care, third party and government insurance provider enrollment. Preferred Position Qualifications: Licenses/Certifications:
        • Certified Provider Credentialing Specialist (CPCS).
        • Certified Professional Medical Services Management (CPMSM). Providence St. Joseph Health (Providence) has worked for decades to improve health and quality of life in California's North Bay region, starting in Sonoma County, where the Sisters of St. Joseph of Orange opened the doors of Santa Rosa Memorial Hospital in 1950. Today, we continue the mission begun by the Sisters to those we serve through an integrated spectrum of primary, urgent, acute, outpatient, palliative care and regional referral services. Sonoma County facilities aligned with Providence include the 278-bed Santa Rosa Memorial Hospital, the region's only Level II trauma center. In addition, the 80-bed Petaluma Valley Hospital and 43-bed Healdsburg Hospital are secular (non-religious) affiliates of Providence. Our services also encompass three Urgent Care centers, Hospice of Petaluma, Memorial Hospice and North County Hospice, the Annadel Medical Group doing business as St. Joseph Health Medical Group, as well as the St. Joseph Home Care Network (post-acute care services). We act as a regional referral hub for outlying hospitals, while also providing outpatient behavioral health care, education to promote health and prevent chronic disease, rehabilitation, oral health care, community benefit programs, and more, all fostering health and quality of life throughout the area. Providence provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Providence complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Positions specified as "on call/per diem" refers to employment consisting of shifts scheduled on as "as needed basis" to fill in for staff vacancies. Company: Sonoma County Entities Category: Administrative ( Non-clinical) Req ID: R355064

Keywords: Providence Health & Services, Santa Rosa , Medical Staff Coordinator - Centralized Credentialing, Healthcare , Santa Rosa, California

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