Credentialing Quality and Education Specialist


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Job Number 43472
Posted 12/9/2016
Account EMHS
Department Credentialing & Prov Data Mgmt
Location Douglas Brown Building - EMHS, ME 04401
Schedule Regular Full-time
Shift Day
Hours 8-4:30
Job Details Job Summary:
The Quality and Education Specialist is responsible for leading, coordinating, monitoring, and maintaining the credentialing process for providers that need to be appointed and/or reappointed as part of their relationship with EMHS and its member organizations.

The specialist is responsible for ensuring credentialing documentation has been secured, primary source verified, analyzed and delivered on behalf of EMHS in a timely fashion and according to policy.

The focus of this role will be on maintaining the quality assurance for the credentialing process via file review and ongoing staff education. This position will support the Credentialing and Provider Enrollment Manager with the ongoing development and implementation of policies and procedures. This position will work with other team leads to identify process improvement opportunities; maximizing use of available technology while streamlining the credentialing process for EMHS.

This position will support the credentialing team by exercising good judgement and processing an ongoing low-volume of applications with additional support regarding prioritization of files for the team.

Job Functions and Duties:
• Responsible for quality assurance on all credentialing applications (appointment/reappointment) to ensure accurate and high quality performance standards are met
• Develops and maintains training materials and department workflows which include assistance with maintaining and implementation of policies and procedures
• Provides introductory and continuous education for all credentialing staff to support the process and cross-training opportunities within the team
• Works in conjunction with leadership to develop and implement project plans for the credentialing process or department.
• Works in collaboration with team leads to develop and implement use of technology and portal resources in an effort to automate processes
• Responsible to have a broad understanding of the credentialing process including data entry, primary source verification, and the quality assurance process so as to complete credentialing as well as support staff with the overall process
• Completes primary source verification process for all EMHS providers, in accordance with, TJC, HFAP, and CMS accreditation standards, Federal and State laws, and EMHS policies.
• Responsible to facilitate delivery of applications for appointment to ensure member needs are met
• Responsible to facilitate delivery of applications for reappointment to ensure members can process reappointments timely
• Completes and provides guidance to staff regarding application analysis including identifying issues requiring further clarification, validation of discrepancies and applicable follow up
• Maintains accurate provider credentialing data electronically via EMHS credentialing software
• Establishes collaborative working relationships both internal and external to the department, communicating timely with staff and customers ; providing updates, orientation, resolving issues, setting goals and maintain standards,
• Processes and distributes appropriate correspondence
• Maintains working knowledge of applicable regulations, policies and procedures.
• Represents the office to internal and external customers as appropriate
• Performs miscellaneous job-related duties as assigned.

Education and Experience
Associates degree required (Bachelor's degree preferred) with 3 - 5 years' experience that is related to the duties and responsibilities as specified.
NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) strongly preferred and/or Certified Professional Medical Services Manager (CPMSM) preferred or must be actively pursuing certification with the ability to become certified within three years of hire, CPCS preferred.

Professional Association: Affiliation and participation with the National Association Medical Staff Services and the Maine Association Medical Staff Services is strongly encouraged.

Regulatory Requirements: Working knowledge of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards. State/federal/licensure regulations, particularly as it relates to the credentialing of physicians and allied health professionals.

Knowledge, Skills, and Abilities
• Excellent attention to details
• Ability to research and analyze documents.
• Ability to work independently, set priorities and meet deadlines with minimal supervision
• Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products and HealthLine Systems ECHO credentialing software preferred.
• Ability to communicate effectively, both orally and in writing.
• Must be able to communicate well with a wide variety of contacts at all levels of the organization.
• Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.
• Ability to maintain confidentiality, work with deadlines and manage multiple priorities.
• Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.
• Ability to train staff; to include organizing, prioritizing, and scheduling work assignments.
• Employee development and performance management skills.
• Knowledge of related accreditation and certification requirements.
• Knowledge of medical credentialing and privileging procedures and standards.
• Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

Physical Requirements
• Works in a normal office environment, requiring the ability to frequently respond to unpredictable situations. Time may be spent sitting at a computer, collaborating with other healthcare team members. Able to work sitting at work station, using a keyboard, working in front of a video display monitor most of the day.
• Repetitive wrist and hand motion.
• Extended use of telephone.
• The ability to reach and stretch intermittently.
• Moderate walking throughout the facility.
• Lite lifting of files and manuals
• Occasional long and irregular hours
• Must be willing to travel by air and ground.
• Tolerance for frequent interruptions
• Flexibility, dexterity, visual acuity, hearing acuity.
• Must be able to speak and communicate clearly and effectively.
• Must be able to adapt to frequently changing work priorities.
• Must be able to travel to various EMHS/non-EMHS sites as there will be occasional travel for off-site meetings, education and/or conference(s).


Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
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