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University of Rochester Credentials Support Specialist - 237187 in Rochester, New York

Credentials Support Specialist Job ID 237187

Location Medical Faculty Group Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 009 URMC Medical Staff Services

Responsibilities

Position Summary:

Participates in departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Serves as a resource of the department, and collaborates with other team members to advance the quality of practitioners and patient safety of the facility.

Specific Responsibilities:

30% Credentialing, Privileging and Verification functions

  • Processes the requests of the departments to initiate the initial and/or reappointment/re-credentialing applications and launches the electronic applications to applicants as applicable.

  • Collaborates with practitioners, departments and staff to collect and verify information to appropriately enter and update practitioner profile data in the credentialing software program when applicable.

  • Conducts initial credentialing and/or re-credentialing for General Medical Education (GME) Students for the Graduate Assistant Staff membership/participation.

  • Analyzes the GME student applications and supporting documents for accurateness and completeness and informs the practitioners of the application status, including the need for any additional information or corrections.

  • Obtains, researches and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards in order to validate the accuracy of applications for one or more decision making bodies.

  • Processes requests for privileges (Competencies) of the GME students when applicable, ensuring compliance with criteria outlined in clinical competency descriptions.

  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues for the department as they arise including and not limited to affiliation verifications requests and requests from legal or regulatory agencies such as the Office of Professional Misconduct (OPMC).

  • Serves as back up to other credentialing staff where applicable and as needed.

  • Serves as a Team Peer Interviewer as needed.

20% Monthly Credentials Privilege and Review Committee (CPRC) Process

  • Prepares the applicant credentials files for presentation to the CPRC process. This includes the collection of documents and completed files and creating combined PDF files for management and committee members to review.

  • Prepare meeting agendas and minutes for presentation to the CPRCs, Medical Staff Committees, and Hospital Boards.

20% Credentialing Software Database Management

  • Monitors and updates staff status of appointments and privileges (Links the electronic Delineation of Privileges to the practitioner files).

  • Prepares board letters and special mailings as applicable and communicates the outcome to practitioners, and department’s representatives as applicable.

20% Ongoing Monitoring of Credentials for Regulatory Compliance

  • Monitors State licenses, DEA and sanction information of the organization’s Medical staff, Allied Health Professional staff, and other Health Professional staff as delegated by outside clients for credentials.

  • In collaboration with other credentialing staff, monitors and communicates with practitioners regarding various time limited requirements such as annual health reviews, PPDs and immunizations, BLS, ACLS, infection control, specialty privilege requirements and board certification status.

  • Communicates with various department representatives and/or outside organizations, clients or affiliates and coordinates efforts to obtain necessary information and/or documentation to assure deadlines are met.

  • Prepares and provides monthly status reports to departments, co-workers, leadership and clients regarding the status of ongoing monitoring and time limited requirements.

10% Liaison/general administrative support for the Medical Staff Services Department

  • Answers the main phone line/retrieve voice mail messages for the department and direct callers as appropriate.

  • Processes incoming and outgoing faxes.

  • Responds to requests for retrieving files from storage.

  • Other administrative functions as needed

Requirements:

Education: Associate Degree required in business or healthcare related field or equivalent combination of education and experience.

Experience: Three years administrative experience required and preferably in Medical Staff credentialing and payer enrollment. Knowledge and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing preferred.

Experience with Microsoft Office applications required. Experience with database applications preferred.

Excellent interpersonal and communication skills with the ability to develop and maintain relationships with a variety of key stakeholders across the organization.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

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