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Credentialing Specialist
MGH Institute of Health Professions
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Credentialing Specialist
MGH Institute of Health Professions
| About Us As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step. Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration. General Summary/Overview: Responsible for the administrative duties required in the credentialing verification process. Reviews, enters and maintains specialized applicant information in a complex database and coordinates the credentialing process for the Medical Staff offices of the respective entities. Ensures the credentialing process complies with organizational as well as accrediting agency, Federal and State regulatory standards. Works in a team environment within the department and with the Medical Staff offices. Principal Duties and Responsibilities: Responsible for the following steps of the credentialing process: • Processing of departmental credentialing requests, in accordance with established procedures and time frames. • Preparation of reappointment packets for assigned area of responsibility. • Tracking of reapplications sent, received, and processing time. • Takes action on non-returned (re)applications and conducts follow-up of incomplete (re)applications in accordance with policies and procedures. • Reviews (re)applications for clarity, quality, and completeness of data in accordance with policies and procedures. • Performs timely and accurate scanning, data entry/entry validation of application information received in the database • Initiation of the verification process within established time frames. • Conducts follow-up on missing data and/or discrepancies in accordance with established time frames. • Responds to verification requests are received, compares the responses with the information provided by applicant to ensure accuracy and completeness. • Works to ensure the verification process is completed within established time frames to allow entity to time to complete the committee reviews prior to appointment/next reappointment date. • Informs entity contacts and CCO team lead/manager, of the verification status of applicants, including providing updates on any potential problems identified during the verification process in accordance with established procedures and time frames • Provides timely resolution of any verification problems/ discrepancies in order to ensure timely completion of the verification process. • Keeps applicants (initial and reappointment) informed of the status of credentialing process which includes timely use of all correspondence as well as proper notification to the applicant. • Serves as a liaison with Medical Staff Offices and other internal/external customers as it relates to practitioner related issues and concerns. Data management, administrative responsibilities: • Maintains an electronic record/file for all practitioners within the credentialing database giving attention to operational concerns and the need for others to retrieve the same records. • Responsible for notifying manager when a policy or procedure is found to be in need of revision due to changes in laws/regulations, inaccurate, or unable to be accomplished as written. • Maintains integrity of electronic, specialized database, which includes the importing of practitioner information in accordance with departmental policies and procedures. • Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation. • Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database. • Assists with the development and revision of the credentialing and audit workflows within the credentialing database. Training and development: • Maintains competency on vendor database via participation in online education learning modules and monthly skills related webinars • Maintains competency on nationally recognized credentialing related initiatives through participation with NAMSS and MAMSS, journal articles, and other industry related news. • Participates in the orientation of new staff members, as assigned. • Use/s the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration • Other duties as assigned Qualifications • High school diploma or equivalent. Associate's or Bachelor's Degree in a related field preferred. • Three to five years experience in credentialing services or related field • CPCS preferred Skills/Abilities/Competencies: • Working knowledge of general office practices and software applications and database management. Demonstrated understanding of credentialing policies and procedures and training program requirements as established by the CCO, as well as accreditation and regulatory requirements relating to the medical staff. • Organizational skills required to handle high data flow and to prioritize tasks in order to meet cyclical deadlines. • Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision. • Analytical skills necessary to determine whether correct and complete information was provided on applications. • Able to concentrate on tasks, paying meticulous attention to detail regardless of distractions. • Possesses ability to manage specialized database, including production of reports covering the area of responsibility. • Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies. • Handles sensitive and confidential situations/information, with a high degree of tact and diplomacy. • Communicates effectively and professionally with applicants or colleagues by telephone or in person. • Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization • Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds an levels within and external to the organization • Strong problem solving and negotiation skills • Requires minimal direction from leadership and possesses the ability to learn quickly Supervisory Responsibility • No direct reports; may indirectly provide leadership and guidance to less seasoned and new staff Fiscal Responsibility • No direct budgetary responsibility • Demonstrates fiscal responsibility by effectively using Partners resources Working Conditions • Possible local travel to Partners sites • While performing the duties of this job, the employee is frequently required to sit; talk; or hear; use hands to finger; handle; or feel; reach with hands and arms. The employee is occasionally required to stand; walk; and stoop; kneel; or crouch. The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision and depth perception. • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Normal office working conditions. The noise level in the work environment is quiet to moderate. EEO Statement Partners HealthCare is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. Partners Healthcare System Inc. is acting as an Employment Agency in relation to this vacancy.
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Internal Number: 3137383-1435_1607615310
About MGH Institute of Health Professions
MGH Institute of Health Professions, founded by Massachusetts General Hospital in 1977, is an innovative and independent graduate school in Boston that is a member of Partners HealthCare. A progressive leader in developing comprehensive models of health care education, the MGH Institute prepares advanced practice professionals in the fields of nursing, physical therapy, occupational therapy and communication sciences and disorders through a distinctive combination of academic study, clinical practice, and research. More than 1,200 students are enrolled in graduate level and certificate programs, with an increasing number of courses available online. The Institute is accredited by the New England Association of Schools and Colleges (NEASC).
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