Credentialing Specialist

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn’t just what we do, it’s how we do it . Each decision we make is rooted in seven core values : Clinical quality Integrity Service excellence Teamwork Accountability Continuous improvement Inclusion Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities.

Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America. At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future.

Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits. Your ideas should inspire change. If you join our team, they will .

Responsibilities

To ensure timely and accurate management of facility practitioners’ credentialing files. Process initial and reappointment applications and provide credentialing resource services to facilities. The Credentialing Specialist will function within CRS policies and procedures, support SCA Health Mission, Vision, and Values.

Direct and manage facility medical staff services and credentialing plan. Directly support facility management and medical staff regarding medical staff services, credentialing of physicians and allied health professionals, and performance management of physicians. Knowledge of Joint Commission and AAAHC accreditation standards, state and federal regulatory requirements, National Practitioner Data Bank (NPDB) querying and reporting requirements, and CMS Conditions of Coverage as it relates to credentialing and privileging.

Working knowledge of current company Medical Staff Bylaws. Working knowledge of credentialing/privileging process for medical staff and allied health professional staff. Effectively applies communication process for medical staff committees. Participates in organization communication and networking related to medical staff services and credentialing through e-mails, phone calls, and conference calls.

Assists in establishing and maintaining continuity in the implementation of standards relating to privileging, physician quality and governance functions. Coordinates and supports facility leadership through the following: Serves as regular resource for medical staff standards, credentialing, and privileging guidelines, required documentation protocols, medical staff file management support, policies and procedures.

Manages and maintains organized documentation and recordkeeping process for all medical staff services: Maintains current electronic forms, policies and procedures to ensure compliance with accrediting and regulatory bodies. Assists with facility-specific compliance requirements related to medical staff and allied health professional credentialing.

Maintains current documentation of compliance with regulatory agencies, accrediting bodies, and governing bodies as it relates to medical staff services and credentialing. Participates with facility related preparations for accreditation survey continuous readiness related to medical staff standards, credentialing, and privileging guidelines.

Promotes medical staff compliance with regulatory and accreditation agencies by monitoring the operations of the medical staff process and effectively initiating change when needed. Maintains a working relationship under advisement of facility management related to issues of credentialing and privileging, Medical Executive Committee Bylaws and Governing Body Bylaws, and Medical Staff Rules and Regulations.

Maintains working knowledge and familiarity with state and federal regulatory requirements, NPDB querying and reporting requirements, and CMS Conditions of Participation as it relates to credentialing and privileging. Maintains information on state-specific physician and allied health professional regulations in the ambulatory setting.

Participates in credentialing meetings and conference calls as assigned and requested. Other duties assigned by Managers.

Qualifications

Minimum of a high school diploma or GED is required Certification (CPCS) preferred in medical staff services credentialing Experience Required: Credentialing experience is preferred Professional with training/experience in medical staff services and credentialing for the ambulatory surgery setting Initiative, good judgment, problem solving skills, decision making skills, strong organization skills, ability to prioritize activities, ability to function independently, effective teamwork skills, professionalism, excellent communication and presentation skills, ability to prepare organized reports, basic computer knowledge, Internet, and Intranet email access required.

USD $58,240.00/Yr. USD $58,240.00/Yr. To ensure timely and accurate management of facility practitioners’ credentialing files. Process initial and reappointment applications and provide credentialing resource services to facilities. The Credentialing Specialist will function within CRS policies and procedures, support SCA Health Mission, Vision, and Values.

Direct and manage facility medical staff services and credentialing plan. Directly support facility management and medical staff regarding medical staff services, credentialing of physicians and allied health professionals, and performance management of physicians. Knowledge of Joint Commission and AAAHC accreditation standards, state and federal regulatory requirements, National Practitioner Data Bank (NPDB) querying and reporting requirements, and CMS Conditions of Coverage as it relates to credentialing and privileging.

Working knowledge of current company Medical Staff Bylaws. Working knowledge of credentialing/privileging process for medical staff and allied health professional staff. Effectively applies communication process for medical staff committees. Participates in organization communication and networking related to medical staff services and credentialing through e-mails, phone calls, and conference calls.

Assists in establishing and maintaining continuity in the implementation of standards relating to privileging, physician quality and governance functions. Coordinates and supports facility leadership through the following: Serves as regular resource for medical staff standards, credentialing, and privileging guidelines, required documentation protocols, medical staff file management support, policies and procedures.

Manages and maintains organized documentation and recordkeeping process for all medical staff services: Maintains current electronic forms, policies and procedures to ensure compliance with accrediting and regulatory bodies. Assists with facility-specific compliance requirements related to medical staff and allied health professional credentialing.

Maintains current documentation of compliance with regulatory agencies, accrediting bodies, and governing bodies as it relates to medical staff services and credentialing. Participates with facility related preparations for accreditation survey continuous readiness related to medical staff standards, credentialing, and privileging guidelines.

Promotes medical staff compliance with regulatory and accreditation agencies by monitoring the operations of the medical staff process and effectively initiating change when needed. Maintains a working relationship under advisement of facility management related to issues of credentialing and privileging, Medical Executive Committee Bylaws and Governing Body Bylaws, and Medical Staff Rules and Regulations.

Maintains working knowledge and familiarity with state and federal regulatory requirements, NPDB querying and reporting requirements, and CMS Conditions of Participation as it relates to credentialing and privileging. Maintains information on state-specific physician and allied health professional regulations in the ambulatory setting.

Participates in credentialing meetings and conference calls as assigned and requested. Other duties assigned by Managers.

Education

Minimum of a high school diploma or GED is required Certification (CPCS) preferred in medical staff services credentialing Experience Required: Credentialing experience is preferred Professional with training/experience in medical staff services and credentialing for the ambulatory surgery setting Initiative, good judgment, problem solving skills, decision making skills, strong organization skills, ability to prioritize activities, ability to function independently, effective teamwork skills, professionalism, excellent communication and presentation skills, ability to prepare organized reports, basic computer knowledge, Internet, and Intranet email access required.