Medical Staff Services Specialist-Medical Staff Office

Overview:

What you will be doing:

Individuals will be under general supervision of the department manager while being responsible for supporting the activities of Medical Staff Services. Responsible for all aspects of re-credentialing, timely renewal of expirables, coordinates quality assessment activities (FPPE/OPPE), provides credentialing support to leadership, accuracy and integrity of the comprehensive credentialing database system, and other duties as assigned that are within the scope of Medical Staff Services.

Ensures compliance with regulatory agencies, such as, The Joint Commission(TJC), National Committee for Quality Assurance (NCQA), Centers of Medicare and Medicaid (CMS), federal and state regulations) as well as Medical Staff and Hospital policies/procedures.

Re-credentialing providers for Partners For Kids is based upon their policies, applicable regulatory requirements and accreditation standards.

Location:

Central Campus700 Children's DrColumbus, Ohio 43205

Why Nationwide Children's Hospital?:

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose.

Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

Nationwide Children’s Hospital. A Place to Be Proud.

Responsibilities:

II. Re-Credentialing

(A) Initiates and coordinates activities related to the re-credentialing and/or privileging of providers in accordance with the Medical Staff Manuals, NCH policies, PFK policies, and applicable regulatory requirements and accreditation standards. Responsible for primary source verification of all necessary documents to complete credential files. Reviews and analyzes credentialing documents, completeness and accuracy, and ensures compliance with defined schedules as determined in the Medical Staff Manuals.

(B) Maintains confidentiality on all matters relating to the responsibilities and operation of Medical Staff Services. Will not disclose or divulge either directly or indirectly confidential information to others unless authorized by the department manager.

(C) Assists providers with completing their re-credentialing materials and answer questions regarding the process.

(D) Maintains organized, up-to-date re-credential files, quality performance profiles, accurate data entry and scanning of documents within the confidential credentialing database. Files all re-credentialing documents.

(E) Assembles all verified information and prepares re-credential files for review and recommendation to hospital leadership, medical staff committees, PFK, and Board of Directors.

(F) Responsible for the accurate, timely and documented verification of information submitted by providers and maintenance of the confidential credentials files.

(G) Identifies adverse information during re-credentialing and determines the need for further investigation with department manager.

III. Expired Documents

(A) Responsible for generating, mailing, tracking, and subsequent processing of all expired documents in a timely manner.

(B) Acquires the updated documentation for the following expired documents including but not limited to:

jBoard status;

kDEA;

lOhio license as well as out of state license;

mProfessional liability insurance and claims history;

nStandard care agreement;

oTB status;

pLife support certifications as specified by delineation of privileges: abls; acls; also; apls; atls; bcls; bdls; bls; cdls; cpr; nals; nrp; pals; etc.

(C) Faxes, copies, scans and files updated documents in the credentials file and confidential database.

(D) Expired document process for Partners For Kids is based upon their policies, applicable regulatory requirements and accreditation standards.

VI. Miscellaneous Credentialing Duties

(A) Initiates process and follows through with monthly credentialing reports approved by the Board of Directors. Such as, requests from providers for changes of status, changes in section/department appointments, leave of absence, resignations, changes in delineation of privileges in a timely manner. Obtains approval from hospital leadership and processes through appropriate mechanism.

(B) Faxes, copies, scans and files updated documents in the credential files.

(C) Updates confidential credentialing database with current information.

(D) Participates in credentialing surveys and audits by regulatory authorities or accreditation as necessary.

(E) Coordinates quality improvement activity files and reports.

(F) Verifies with providers and notifies appropriate hospital staff of changes to demographic information. Follows through with verification of other pertinent information. Updates files and data base as appropriate.

(G) Credentialing changes for Partners for Kids are based upon their policies, applicable regulatory requirements and accreditation standards.

(H) Performs miscellaneous job-related duties as assigned.

Qualifications:

VI. Minimum Qualifications Required

(A) High school diploma.

(B) Minimum two-four years administrative office experience in a healthcare setting. Knowledge of credentialing procedures and standards is preferred.

(C) Good computer skills with proficiency in Microsoft Windows and willingness to learn comprehensive credentialing software.

VII. Knowledge, Skills and Abilities

(A) Ability to communicate professionally, both verbally and in writing.

(B) Ability to cross-train when directed by the department manager in order to provide coverage during extended absences and vacancies in positions.

(C) Ability to work under pressure, prioritize, and organize multiple tasks and projects in a fast-paced team environment. Excellent time management skills to meet stringent deadlines

(D) Acts as a resource person for leadership, practitioners and allied health professionals.

(E) Advises the department manager of any problems or perceived problems with practitioners and allied health professionals.

(F) Assists in the coordination of special projects and/or procedural projects as determined by the department manager.

(G) Assists the department manager with other duties as assigned for smooth operation of credentialing activities.

(H) Communicates and works efficiently and effectively with leadership regarding credentialing issues in their respective areas.

(I) Credentialing duties and responsibilities for Partners For Kids are based upon their policies, applicable regulatory requirements and accreditation standards.

(J) Database management skills including querying, reporting, document generation, etc.

(K) Demonstrate the ability to work as a cooperative and respectful team member.

(L) Demonstrate initiative and resourcefulness in executing duties with minimal supervision.

(M) Detail oriented, able to adapt to frequent work interruptions in a calm and positive manner, handle multiple tasks, and prioritize tasks,

(N) Excellent customer service skills; pleasant, cordial and speak with a high degree of tact and diplomacy. Must maintain a positive professional relationship with all individuals that are in contact with the Medical Staff Office

(O) Exhibit a clean, neat, friendly and professional appearance.

(P) Flexible and adaptable to process changes and deadlines.

(Q) Knowledge of the Medical Staff Manuals, department and/or section rules and regulations, state and federal regulations, and external agency standards as they apply to credentialing, e.g., The Joint Commission; National Committee for Quality Assurance; Centers for Medicare & Medicaid Services, etc.

(R) Manages highly sensitive and confidential credentialing information

(S) Maintains organized filing system.

(T) Maintains positive customer service communication with medical staff, allied health professionals and other internal and/or external individuals in striving to create a collaborative effort with credentialing.

(U) Manage telephone activity providing responses and follow-up to a variety of requests, problems, and complaints.

(V) Organizes and orders refreshments for Graham Lounge as well as performs housekeeping duties.

(W) Processes incoming mail.

VII. Minimum Physical Requirements

(A) Physical requirements include lifting and carrying files; standing; walking; sitting; stooping; kneeling; reaching; full use of hands and arms; good visual and auditory skills. Ability to sit and use computer equipment for long periods of time.

(B) The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Permanent