Credentialing Specialist (#RO4130)
$24.40-$29.66 Hourly / $4,229.00-$5,140.37 Monthly / $50,748.01-$61,684.52 Yearly

Under general supervision, coordinates the credentialing and recredentialing process for the medical staff and allied health professionals in the Department of Health Care Services to ensure conformance with applicable regulations and laws; and does related or other work as required in accordance with Rule 3 Section 3 of the Civil Service Rules.

An incumbent in this single position class is responsible for the coordination of all medical staff and allied health professional credentialing and recredentialing of medical staff in compliance with policies, procedures, laws and regulations. Supervision is received from the Medical Staff Coordinator who oversees credentialing and medical staff training programs.

• Collects, monitors and evaluates all credentialing and recredentialing documentation for applicants, medical staff members and allied health professionals in Health Care Services; ensures applications are complete in accordance with department by-laws, rules and regulations, Joint Commission on Accreditation of Health care Organizations (JCAHO) Medical Staff Standards, Department of Health Services (DHS), California Medical Association (CMA), state and federal requirements, and Standardized Procedures and Protocols for Mid-Level Practitioners. 
• Receives and processes medical staff applications for permanent and temporary privileges; reviews and analyzes applications for required criteria; performs source document verification of each application, including education, internships, residency, hospital affiliations, detailed analysis of confidential information, and all other required information according to credentialing policies and procedures; contacts various agencies to obtain verifications through written, verbal or internet communications; secures and interprets confidential reports from various medical agencies; processes applications within timeframes designated by procedures and protocols. 
• Prepares and distributes credentialing and recredentialing applications as required by JCAHO, DHS, SMA, state and federal regulations; prepares and processes release forms; processes completed applications, including all source document verifications; forwards for review and completion by medical executive committee. 
• Enters credentialing data into database; maintains and secures confidential credential files for all members of the medical and allied health professional staff; insures that files are only accessed by appropriate personnel; processes personnel action requests, as instructed. 
• Prepares documents for various committees and governing bodies; prepares reports and correspondence. Gathers and researches confidential information for disciplinary proceedings. 
• Coordinates, schedules, and attends monthly committee meetings; prepares documents for oversight committees for action on credentialing, recredentialing, discipline or other actions; distributes correspondence to key staff on the outcome of meetings; attends other meetings as assigned. 
• Attends meetings, trainings and conferences as assigned; informs supervisor of any updated credentialing requirements. 
• Provides clerical support as required.

Experience: Two years experience performing medical staff credentialing functions or providing administrative clerical support to medical and/or management staff in a health care environment, preferably in an acute care hospital, health maintenance organization or manage care facility.

California Medical Board licensing regulations covering physicians, podiatrists, psychologists, dentists, and other practitioners; physician credentialing processes and allied health care professional credentialing processes as required by the Joint Commission on the Accreditation of Healthcare Organizations and State of California regulations; medical terminology; medical staff bylaws; regulations of the California Association of Hospitals and Healthcare Systems governing physicians practicing in the State of California; principles of effective oral and written communication; public relations techniques; methods of gathering and organizing data; record keeping principles and techniques; basic statistics and graphics.

Coordinate a complex medical staff credentialing program; maintain confidentiality of sensitive and privileged medical staff and patient care issues; interpret and explain a wide variety of technical and medical information; establish and maintain effective and cooperative working relationships with administrators, physicians, and other staff; maintain computer databases and create reports using database; meet deadlines; read, understand and apply written regulations and other job related materials, exercise diplomacy and tact, maintain a level of objectivity while resolving credentialing issues; demonstrate good customer service practices; exercise good judgment; exercise confidentiality.

Mobility-Frequent operation of a data entry device; repetitive motion; sitting for long periods; walking; occasional standing, pushing, pulling, bending, squatting, climbing; Lifting-Frequently 5 pounds or less; occasionally 5 to 30 pounds; Visual-Constant good overall vision and reading/close-up work; frequent color perception and use of eye/hand coordination; occasional use of depth perception and peripheral vision; Hearing/Talking-Frequent hearing of normal speech; hearing/talking on the telephone; talking in person; Emotional/Psychological-Frequent decision making, concentration, and public contact; Special Requirements-Some assignments may require working weekends, nights, and/or occasional overtime; Environmental-Occasional exposure to varied weather conditions.