Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of credentialing, including initial appointment, reappointment, expiration process, as well as clinical privileging. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity and developing a credentialing database system and related applications.
·Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
·Conducts thorough investigation, research, and primary source verification of all components of the application file.
·Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
·Prepares credentials file for completion and presentation to Credentials Committees, ensuring file completion within required time periods.
·Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege delineation.
·Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day credentialing/privileging issues as they arise.
·Assists with audits performed by accrediting or regulatory bodies.
·Perform internal file audits.
·Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.
·Monitors the initial, reappointment, and expirable process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements
·OPPE/FPPE data collection/review as assigned
·Maintains strict confidentiality of all data and information.
·Performs miscellaneous job-related duties as assigned.
Bachelor's Degree or equivalent job-related experience
Minimum of at least three (3) years experience related to a hospital or managed care credentialing.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.