Job Summary Under the general supervision, the Credentialing Specialist is responsible for providing credentialing and credentialing support to the Network Medical Staff through the processing of applications and reapplications to ensure that only qualified practitioners provide care within the network facilities. Provides credentialing support to the centralized appointment and reappointment process including reports and obtaining required data from Quality Assurance profiles and National Practitioner Data Bank reports, in accordance with the National Commission on Quality Assurance (NCQA), The Joint Commission, and the Arizona Department of Health Services (DHS) standards.
Provides credentialing support to the credentialing manager. Maintains a sound working knowledge of credentialing and provides consultation to the medical staff regarding credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies as demonstrated by observation.
Responsible for timely processing of initial applications and reappointment applications for completeness and in accordance with Medical Staff standards. Secures appropriate peer competency references and prepares credentials files. Obtains primary source and other verifications in accordance with established guidelines. Communicates with applicants during credentialing process to ensure timely and expeditious completion of process. Researches incidents, malpractice claims, advisory letters/letters of concern etc and request appropriate follow-up information from practitioner or other sources as indicated.
Maintains the credentialing database . Updates primary source data in the Midas database. Ensures data is accurately entered as evidenced by audit. Prepares reports in compliance with requests for information as demonstrated by documentation.
Maintains adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical and hospital and medical staff policies. Assures data security and confidentiality by use of appropriate labeling of information and storage, and appropriately securing cabinets and drawers.
Internal Number: 2018-12504
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We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.
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