Credentialing Analyst I, Corporate, Full Time, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary

Accountabilities

• Provides consultation to Prisma Health UMG provider Allied Health Professionals for clinical privileges with regard to the application and reapplication process. Also provides consultation to Prisma Health UMG AHP providers for enrollment with Delegated Managed Care contracts with regard to the application and reapplication process.
• Reviews, gathers, investigates and analyzes all data pertaining to credentialing of the Allied Health Professionals. Using discretionary ability, determines, according to Hospital Policy and Procedures whether an applicant/reapplicant can be processed as Dependent or Independent practitioner. Presents findings to Allied Health Practitioner Committee and/or Vice President Medical Affairs as appropriate for review and approval or recommendation ultimately to the Board of Trustees.
• Responsible for scheduling and conducting all office site visits required for primary care practices as a requirement of the Prisma Health UMG Provider Credentials Program Plan.
• Develops relationships with and serves as Medical Staff Services liaison with applicants for appointment/reappointment of clinical privileges, other hospital managers and Allied Health Practitioner Committee. Also assists in the development and maintenance of necessary ancillary provider relationships to include, but not limited to Behavioral Health and Greenville Pivital Therapy .
• Maintenance of Prisma Health UMG Allied Health Professionals portion of Medical Staff provider database in Medical Staff Services Department as well as the Allied Health Professionals portion of the Prisma Health Doctor Master File and PR Doc mainframe as well as notification of any additions/deletions/ changes to appropriate hospital departments. Maintains Prisma Health UMG provider database as well as notification of any additions/deletions/changes to delegated Managed Care Plans.
• In accordance with JCAHO accreditation standards, keeps appropriate hospital departments informed of privileges and any changes thereto of all Prisma Health UMG Allied Health Professionals.
• Conducts necessary research and provides follow-up on provider participation issues.
• Maintains confidential files of all Allied Health Professionals (employed/contracted) to include confidential health forms in order to meet ADA guidelines Maintains confidential files of all Prisma Health UMG AHP Provider members in order to meet NCQA, URAC and delegated MCO standards.
• Keeps abreast of JCAHO, NCQA, URAC and other regulatory and legal requirements alerting appropriate individual/group of any changes applicable to that specific area.
• Assumes responsibility and accountability for portion of department work assigned; assists co-workers as needed for effective/efficient operation of department.
• Performs other duties as assigned or as may be needed/required to meet emergency situations with regard to the department.

Supervisory/Management Responsibility

This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• High School diploma or equivalent
• 5 years of Administrative/Clerical responsibility in a Healthcare setting, including 3 years experience in Medical Staff Services or a relating setting in administrative support, allied health credentialing or certification. Database management experience required. Crystal Reports experience preferred

Required Certifications/Registrations/Licenses

N/A

In Lieu Of The Above Minimum Requirements

N/A

Other Required Skills and Experience

• Considerable knowledge in administration and management, medical terminology, principles of medical staff organization and healthcare finance, accreditation and healthcare law.
• Ability to analyze administrative problems and make appropriate decisions.
• Ability to develop and maintain effective relationships with Medical Staff and other professionals in order to engender confidence, respect, and dependability.
• Ability to maturely handle a variety of problems and situations, often of a critical or urgent nature using considerable independence and sound judgment. Ability to maintain confidentiality in all aspects of position.

Work Shift

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Facility

Department

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