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Credentialing Specialist CVS

Company: Baylor Scott & White Health
Location: Killeen
Posted on: May 4, 2021

Job Description:

Description - External
Under general supervision, responsible and accountable for all functions of the Credentialing Specialist CVS relating to credentialing and re-credentialing and the clinical privileging (as applicable) of the medical staff and delineation of services for the allied health professionals as appropriate for the Baylor Scott & White Health. Responsible for the accuracy and integrity of the credentialing and clinical privileging database system (as applicable). Functions as a Credentialing Specialist to assure optimum performance of the department. Is knowledgeable about Joint Commission for Accreditation of Healthcare Organizations (TJC) and Center for Medicare and Medicaid Services (CMS) and other regulatory agencies as they pertain to medical staff and allied health professionals.
Coordinates and maintains the credentialing, re-credentialing of new applications and reappointment applications and clinical privileging (as applicable) for the medical staff and allied health professionals in compliance with the medical staff bylaws, rules and regulations, medical staff policies and procedures, AHP policies, TJC, CMS standards and other regulatory agencies.
Processes and maintains confidential medical staff and allied health professional data files requests for, but not limited to:
- New applications
- Reappointment applications
- Staff category changes
- Resignations/ Retirement
Obtains all applicable affiliations by utilization of verification software/databases as well as approved verification sites via the internet primary source information and references.
Obtains all applicable education by utilization of verification software/databases as well as approved verification sites via the internet primary source information.
Sends appropriate communication and provides follow up to practitioners.
Reviews privilege cards and supporting documentation for accuracy and completion.
Record all incoming mail/supporting documentation in credentialing software system.
Quality Audit/Review
- Analyze file for completeness
- Conduct final audit of completed applications and privileges (if applicable)
- Confirm checklist data entry is complete
- Provide final follow-up as necessary
- Communicate incomplete status with applicants, facilities and CVS Leadership
- Maintains data integrity of the credentialing software database according to established policies and procedures
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 facilities, practitioners, allied health professionals and administration.
Performs other duties as required. Job duties are subject to changes as directed by management.
KNOWLEDGE, SKILLS, AND ABILITIES:
Knowledge of Health Line System (Medical Staff Line and/or Echo) or other credentialing system preferred.
Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.
Advanced computer skills in word processing, spread sheets and databases
The information contained in this job description is intended to describe the essential job functions required of those assigned to this job. It is not intended to be an exhaustive list of all responsibilities, duties, knowledge, skills, and abilities needed to perform the job. Please note that management retains the right to assign or reassign duties and responsibilities to this job at any time. The ability to competently perform all the essential duties of the position, with or without reasonable accommodation, demonstrated commitment to effective customer service delivery, integrity, and the ability to work productively as a member of a team or work group are basic requirements of all positions at Baylor Scott & White Health.
MINIMUM REQUIREMENTS ADDENDUM:
Associate's degree or equivalent preferred but not required (i.e. some college).
Requires 1-3 years of experience in health care credentialing/ verification
License(s)/Certification(s):
Requires Medical Staff Services certification: Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS)

Qualifications - External
QUALIFICATIONS

- EDUCATION - Assoc or Equiv Experience

- EXPERIENCE - 1-3 years experience required

- CERTIFICATION/LICENSE/REGISTRATION -
Cert Medical Staff Coord (CMSC), Cert Provider Credentling Spec (CPCS), Cert Prof Medical Services Mgr (CPMSM): Requires one of the following certifications: Cert Professional Medical Services Management (CPMSM), Cert Medical Staff Coord (CMSC) or Cert Provider Credentialing Specialist (CPCS) or must obtain with in twenty-four (24) months from date of hire.

QUALIFICATIONS

- EDUCATION - Assoc or Equiv Experience

- EXPERIENCE - 1-3 years experience required

- CERTIFICATION/LICENSE/REGISTRATION - &nbspCert Medical Staff Coord (CMSC), Cert Provider Credentling Spec (CPCS), Cert Prof Medical Services Mgr (CPMSM): Requires one of the following certifications: Cert Professional Medical Services Management (CPMSM), Cert Medical Staff Coord (CMSC) or Cert Provider Credentialing Specialist (CPCS) or must obtain with in twenty-four (24) months from date of hire.

Keywords: Baylor Scott & White Health, Killeen , Credentialing Specialist CVS, Other , Killeen, Texas

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