Duties and Responsibilities

Essential Functions:

• Provides support of physician and advanced practice provider initial/provisional credentialing and reappointment processes and ensures credentialing activities are completed accurately and within appropriate timeframes.
• Provides support of credentialing by maintaining an accurate, secure, and current database of all physicians and advanced practice providers.
• Employs critical thinking and independent judgment to evaluate and determine an applicant’s eligibility for Medical Staff membership and privileges. Utilizes various internal and external resources and databases to gather and analyze physician and advanced practice providers credentialing and performance data used in the reappointment, peer review, and performance improvement processes of the medical staff.
• Leverages systems such as Symplr, Cactus, Axuall and SailPoint.
• Monitors timely and satisfactory completion of mandatory educational and training elements, including, but not limited to, LMSand privilege-specific training requirements.
• Recognizes, investigates, and validates discrepancies and adverse information obtained from credentialing applications, primary source verifications, or other sources.
• Utilizes critical thinking and discretion to maintain peer review and professional conduct protection, escalate safety and quality concerns, and recognize legal implications of credentialing functions.
• Collaborates with medical staff leaders and/or senior administration regarding confidential and time sensitive issues, to guarantee accurate review of provider credentials and qualifications.
• Drafts appropriate correspondence utilizing knowledge of state statutes and legal guidelines in requesting additional information from external medical and legal sources.
• Manages the collection and compilation of performance data for physician and advanced practice provider’s quality profiles, including references for low volume providers.
• Compiles, evaluates and presents accurate and complete initial/provisional and reappointment applications, as well as all pertinent credentialing and accreditation information to Medical Staff leadership, Credentials Committee, Medical Executive Committee and the Board of Directors for review and appropriate action.
• Provides support to the medical staff, particularly elected and appointed Medical Staff Officers.

Common Expectations:

• Maintains adherence to required timelines in accordance with applicable section standards and expectations.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Inspires trust and confidence amongst stakeholders through reliability, authenticity, and accountability.

Travel Requirements:

• Estimated Amount: - Travel required, with occasional travel expected across system.