Department:OH1CH_70517_000 MCHP Provider Credentialing
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
The Credentialing Coordinator is responsible for implementation and appropriate documentation of all regulatory agency (i.e. ODH, CMS, NCQA, Joint Commission, etc.) and other Mount Carmel Health System requirements related to credentialing of the Mount Carmel hospitals’ medical staff and joint ventures. Administrative functions include primary source verification of credentialing applications, to include critical analysis of a provider's clinical competence through assessment of case logs and specific training. Credentialing liaison with Mount Carmel joint ventures as well as other credentialing entities in the health system.
- Prepare for and attend regulatory surveys (i.e., Joint Commission, ODH, CMS, etc.) as needed.
- Maintain a working knowledge of the Medical Staff's governing documents including but not limited to Bylaws, Credentialing Policy, Allied Health Professional (AHP) Policy, FPPE policy, etc.
- Responsible for all office activities and functions related to credentialing and privileging including but not limited to processing initial and reappointment applications, additional privilege requests, category changes, withdrawn privilege(s) requests, additional facility requests, resignations, expirables, delineation of privilege updates/revision requests, case log summary forms, FPPE forms/documents etc.
- Responsible for data entry and preparing and updating practitioner applicant files and routine maintenance of computer database upgrades.
- Critically analyze all physician and AHP applications to ensure eligibility criteria for staff membership and/or clinical privileges are met for all areas of credentialing and/or privileging.
- Coordinate, implement, and follow up on all Focused Professional Practice Evaluation (FPPE) practitioners.
- Process temporary privileges for providers on new applications and requests for additional privileges, as requested.
- Conduct all functions of Board of Trustees recommendations to ensure practitioner privileges and/or medical staff membership are effective and practitioner can begin or continue working within MCHS.
- Ensures that all provider data is current and compliant with regulatory agency requirements including but not limited to malpractice insurance, DEA certificates, OH state licensure, board certification, etc., and immediately informs MSS leadership of status and/or issues or concerns.
- Tracks and reports on the status of all physician and AHP applicants in process on a weekly basis to ensure that credentialing functions are being performed in a timely manner and in accordance with MCHS needs and regulatory agency requirements.
- Prepares confidential correspondence and documentation for providers including but not limited to credentialing matters such as criminal background checks, malpractice claims, disciplinary actions, etc.in conjunction with manager and/or lead coordinator.
- Travel as required.
- All other duties as assigned.
- Education: Associate degree in administration, health or behavioral science field preferred.
- Licensure / Certification: Certified Professional Credentialing Services (CPCS) and/or Certified Professional Medical Staff Services Management (CPMSM) certification preferred; (National Association of Medical Staff Services)
- Experience: Minimum of two years' experience performing administrative duties; Experience working with physicians preferred. Credentialing experience preferred.
- Knowledge of medical terminology and external regulatory requirements ( ODH, Joint Commission, NCQA, etc.), preferred.
- Ability to adapt to the changing needs of MCHS and MSS department.
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Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.