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Credentialing Analyst
Ref No.: 18-10741
Location: San Francisco, California
Start Date: 08/22/2018
Job Description
Within a high volume, goal driven environment (estimated target: 25 files per week), initiates and cultivates partnerships with department management, medical staff and hospital leadership to ensure compliance and optimal efficiency for appropriate membership, privileges and health plan enrollments for Client Staff, Advanced Health Professionals and CVO contracted facilities (LPPH&C, School of Dentistry and others, as applicable). Monitors onboarding and revenue channel disruptions as well as performs auditing functions pursuant to facility Bylaws, Rules and Regulations; Credentialing Policy and Procedures; and other applicable accreditation/payor standards (e.g. NCQA, TJC, Client, DMHC, CMS, delegated credentialing agreements, etc.) Facilitates and supports committees and continuous performance improvement efforts to achieve department and organization goals/workplans. Implements policy and procedures, provides training and orientations to a variety of constituents and supports efforts to sustain best practices.
REPORTING RELATIONSHIPS
No supervisory responsibilities/relationships.


Required Licenses/Certifications
  • Bachelor's degree or equivalent combination of education and experience
  • A minimum of three years in healthcare environment with emphasis in medical staff operations, academic medical centers and/or provider credentialing for third party payors and health plans.
  • Knowledge of TJC, NCQA, CMS, Client, DMHC, ACGME and other applicable accreditation/regulatory requirements
  • Advanced competency in a paperless computer environment and understanding of provider data integrity standards (credentialing software, MS Office suite, Adobe Professional, document scanning/storage, web based applications and tools, etc.)
  • Excellent ability to: interact with all levels of management; communicate effectively, both verbally and in writing; and, function within a team and independently.
  • Exceptional organizational skills and ability to set priorities as well as manage multiple demands effectively.
  • Maintains confidentiality and discretion to preserve HIPAA/Peer review protections as well as attorney-client privilege, as warranted.
  • This position requires flexibility to orient and work at all CLIENT'S Medical Center locations.

Duties & Essential Job Functions:

%
of time
Essential Function (Yes/No)
Key Responsibilities
(To be completed by Supervisor)
40% Yes Cultivate and produce efficient and compliant onboarding processes, such as:
· Pre-application intake and monitoring
· Application submission and data analysis
· Reappointment/revalidation and related competency assessments (FPPE/OPPE)
· Auditing and quality review of credentialing program
· Discrepancies/flagged items, requiring additional comment/consideration
· Board Actions, temporary/visiting privileges
20% Yes Serves as functional expert for Credentials Committee, Committee on Interdisciplinary Practice (CIDP) and/or CVO clients. Collaborates with department chairs' regarding scope of practice and new privileges within clinical services/programs. Prepares agendas, minutes, reports, presentations, correspondence, emails, scheduling and logistics for committees'/CVO clients' functional responsibilities and delegated credentialing agreements.
20% Yes Researches and resolves disruptions to revenue channel due to medical staff data integrity. Partners with department leaders to ensure alignment with onboarding priorities and optimize patient access to qualified providers. Establishes priorities and initiates temporary privileges to resolve and align patient access within organizational work plans/priorities.
10% Yes Initiates procedures and leadership communication to administratively suspend/reinstate provider's status and clinical access to patient services. Draft action plans for leadership approval/recommendation and monitor actions through reinstatement to ensure compliant resolution.
10% Yes Facilitate and lead quality/process improvement projects as assigned, such as: desktop procedures, new privilege implementation, data integrity, workflow development, training/education, storage/archive digital documentation or other, as warranted, per department goals/initiatives.
100% (To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.)