Medical Staff Specialist (1.0) - Billings Clinic

Medical Staff Specialist (1.0)
MEDICAL STAFF SERVICES (BILLINGS CLINIC HOSPITAL)

Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)
Starting Wage DOE: $20.66 - 25.83

Coordinates and conducts thorough credentialing which ensures that every physician and medical associate/assistant, who provides ambulatory and inpatient services at BC facilities, is fully trained and qualified to provide the treatments and procedures requested. Provides administrative oversight of BC-practitioner licensing, board certifications privileges at other facilities, and maintenance of credentialing-related records required for all affiliations and managed care payer contracts.

ESSENTIAL JOB FUNCTIONS
* Coordinates the credentialing process of physicians and other practi-tioners who provide patient care in BC facilities and are mem¬bers of provider panels for third-party payers. Credentials and recredentials all practitioners who utilize hospital facilities and provide ambulatory patient care in BC facilities. Analyzes information provided by applicants and individuals/entities who verify applicant's qualifications, and ensures that these functions are carried out in the time period required. Makes decisions on how and when the following are done based on Medical Staff Services policies and Medical Staff Bylaws: initial verifications of qualifications and clinical competency; bien¬nial recredentialing and privileging; queries to all required national data¬banks, licensing boards, and certification boards; review of new applicants and reappointments by MSS Manager; communications to individuals and committees responsible for credentialing decisions; ongoing individual compliance to medical staff requirements; and maintenance of all computer databases and physical records containing these elements.
* Responsible for carrying out credentialing processes in compliance with BC medical staff bylaws, legal requirements, accrediting agen¬cies, and third-party payer contracts. Demonstrates compliance to BC management, physician leadership, accreditors, and auditors.
* Acts as an advocate and a resource to BC Leadership and physicians, assisting with orientation of new providers, communicating and interpreting by-laws, policies, procedures and methods; communicating preliminary findings on applications and making recommendations for the need for further clarification and/or investigation.
* Assists with professional services and resources for BC practitioners (including licensing, certifications, clinical privileges held at other facilities, CME documentation), and independently imple¬ments processes which ensure well-organized service and record keeping. Acts as a resource to Medical Staff Secretary on performing tasks associated with professional services. Develops a rapport with individual practitioners, mana¬gers, physician leadership, and external customers and resources to facilitate efficient operations and information management.
* Provides guidance and support to contracted credentialing verification services provided by Medical Staff Services, ensuring that the processes are scrutinized for compliance with National Committee Quality Assurance (NCQA) standards and national standards relating to credentialing verification organizations.
* Assists with the development of departmental and hospital policies and procedures involving the credentialing process by delineating actual practices.
* Develops and maintains medical staff databases. Responsible for updating and maintaining medical staff information systems. Co