The credentialing specialist is responsible for a review and analysis of the full array of information collected for the purpose of credentialing / recredentialing doctoral and mid-level clinicians and organizational providers according to CMS, Joint Commission and State and Federal regulations. The Credentialing Specialist determines the completeness, accuracy and consistency of the data collected and initiates the gathering of additional information from internal and external sources as needed in order to bring files to closure. The Credentialing Specialist determines whether credentialing/re credentialing applicants meet organizational criteria for approval by the Medical Executive Committee.
Initiates the collection of data for credentialing through automated credentialing systems and the internet, as determined for issues files.
Ensures all files are complete and ready for Committee.
Analyzes issues/concerns identified in provider files for completeness, accuracy, consistency, gaps in time, lack of hospital admitting privileges, low insurance coverage, relevant references, etc. Identifies substantive issues and initiates further data collection as needed, from internal and external sources.
Maintains thorough understanding/knowledge of the CMS/TJC credentialing standards and how they relate to the credentialing/recredentialing processes. Maintains thorough understanding/knowledge of the hospital medical staff policies including Medical Staff Bylaws, Rules and Regulations relating to the credentialing/recredentialing processes.
Familiar with all systems that support credentialing processes.
Coordinates the credentialing/recredentialing process and acts as liaison with hospitals and other health care entities with which we have delegated credentialing.
Processes all files according to all process steps and within required deadlines.
Maintains production and quality performance standards.
Evaluates workflow for speed and efficiency. Evaluates quality improvement and makes suggestions to supervisor and team members for increasing effectiveness. Identifies potential problems and proposes solutions.
Maintains credentialing files and related documents.
Performs other duties as assigned.
Northwest Medical Center is comprised of a 300-bed hospital, four urgent care facilities, a freestanding emergency center and a large physician group, offering you a variety of settings in which to work. Every location is dedicated to providing safe, quality patient care, but more than that is the commitment to employees. It strives to provide a culture of teamwork, respect and appreciation for all staff, whether they care for patients directly or work in a support role. With employee appreciation celebrations throughout the year, opportunities for growth and the satisfaction that you are part of a hospital leading the way with accessible, convenient healthcare in Tucson, Northwest is a great place to work. NMC is accredited by The Joint Commission and is an equal opportunity employer: race, gender, disability and Veteran status, and VEVRAA Federal Contractor - priority referral Protected Veterans requested.
Internal Number: 15780391
About Northwest Medical Center
For Northwest:Northwest Medical Center is a 300-bed community hospital with comprehensive inpatient and outpatient services, ranging from emergency to cardiac, critical care, labor & delivery and beyond. We are nationally accredited in several areas including stroke, chest pain, heart failure and joint and spine surgery. Our mission is to provide the communities we serve with high-quality cost effective and safe health care.For Oro Valley:Oro Valley Hospital has been nationally recognized for its quality care including designation as a Chest Pain Center, NICHE, PEDS "Pediatric Prepared", Primary Stroke Center, STEMI Receiving Center and Trauma Level IV. That coupled with a beautiful hospital in a scenic location makes Oro Valley Hospital an exceptional place to work.