Credentialing Spec

at  Baylor Scott White Health

JOB SUMMARY

Under general supervision, accountable and accountable for all functions relating to the administrative work in coordinating credentialing and re-credentialing and the clinical privileging of the medical staff and delineation of services for the allied health professionals and others as appropriate for the Baylor Scott & White Health. Accountable for the accuracy and integrity of the credentialing and clinical privileging database system. Functions as a member of the team to assure optimum performance of the department.
Provides information and guidance about medical staff bylaws, medical staff rules and regulations, allied health professionals (AHP) policies, Joint Commission for Accreditation of Healthcare Organizations (JCAHO) and Center for Medicare and Medicaid Services (CMS) and other regulatory agencies as they pertain to medical staff and allied health professionals. Requires Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) or education plan to obtain in eighteen (18) months from date of hire.

QUALIFICATIONS

• EDUCATION - Bachelor’s
• EXPERIENCE - 10 Years of Experience

• Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff and allied health professionals in compliance with the medical staff bylaws, medical staff policies and procedures, AHP policies, JCAHO, CMS standards and other regulatory agencies.
• Processes confidential medical staff and allied health professional files requests for, but not limited to new applications, reappointment applications, temporary applications, more privileges, staff category changes, resignations / retirement.
• Maintains data integrity of the credentialing and clinical privileging software system. According to established policies and procedures, accountable for the integrity of data
• Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet.
• Ensures maintenance of medical staff and allied health professional files.
• Ensures that results of medical staff quality management findings are provided to appropriate review committees/ departments and maintained in a confidential file.
• Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.
• Acts as a liaison between the medical staff, allied health professionals, nursing services and administration.
• Performs other duties as required. Job duties are subject to changes as directed by management.
• Accountable for recording and maintaining clinical privileges for physicians and allied health staff members in the database.