Coordinate the credentialing process for initial appointment and reappointment for the medical and allied health professional staff. Manage the compliance to ensure all individuals with clinical privileges provide services within the scope of their training, licensure and individual clinical privileges granted.

Responsibilities:

• Critically review primary source verification (psv) scanned documents to determine any incorrect, omitted or discrepancies in data entry and psv requests.

• Identify any issues in file red flags requiring further review.

• Obtain quantitative and qualitative data for practitioners in the credentialing process either from applicant (initial appointments), internal databases (reappointments - Impromptu/Corporate Database) or from practitioner's primary facility.

• Ensure complete and accurate credentialing information is provided to chiefs and chairpersons to enable them to make informed decisions regarding clinical privilege delineation.

• Implement process for re-credentialing of physicians and allied health professionals to the medical staff to adhere to regulatory standards.

• Maintain knowledge of latest recommendations for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), National Commission on Quality Assurance (NCQA) the State Medical Society, and other state requirements particularly with reference to accreditation standards.

• Forward appropriate individuals and callers to Director as required.

• Call outside repair services as necessary.

• Prepare and disseminate invitations, track responses, create seating arrangements, for review and approval, select and retain entertainment, purchase gifts and prizes, and checking-in invited guests at events as necessary.

• Ensure all individuals with clinical privileges provide services within the scope of their training, licensure and individual clinical privileges granted.

• Initiate any additional psv required per established policies and procedures.

• Proactively obtain supporting documentation to support requests for privileges by developing contacts with other facilities and medical leaders.

• Ensure data is entered into facility areas of credentialing system following board approved credentialing actions.

• Assist with the coordination of Medical Staff social activities.

• Compare psv, curriculum vitae and credentialing information form.

• Upon receipt of completed hospital-specific packets, initiates data collection and compilation from Centralized Verification Office (CVO).

• Validate data monthly to assure accuracy.

• Provide support to the Medical Staff Officers, Committee Chairmen and members, and other healthcare professionals in the development of mechanisms to assess physician performance, identify potential risks, and document disciplinary action throughout the credentialing process - initial appointment and reappointment.

• Coordinate office maintenance as required.

• Review and correct, if applicable, data entered by the CVO. Notify CVO of discrepancies or errors.

• Maintain credentialing schedules and status reports for practitioners in the credentialing process.

• Ensure sufficient quantities of supplies are available.

• Create physician profile for quick reference by medical staff leadership.

• Obtain any additional information requested.

• Maintain and coordinate facility-specific data entry for physician database to reflect credentialing actions.

• Coordinate the credentialing process for initial appointment and reappointment for the medical and allied health professional staff.

• Maintain a working knowledge of the Hospital Bylaws, General Rules and Regulations, Medical Staff Bylaws, General Rules and Regulations and Department Rules and Regulations.

• Maintain Medical Staff Conference Room Calendar - data enter meetings into centralized calendar and prints hard copy for door.

• Complete and track work order requests.

• Coordinate and facilitate both the informal and formal credentialing peer review/recommendation process per established policies and procedures.

• Forward and track complete files to Division Chiefs and Department Chairmen for approval.

• Adhere to departmental time frames for file completion.

• Compile and create practitioner files including all pertinent information in accordance with departmental policies.

• Answer phones/screen visitors.

• Closely monitor information collection; cognitive analysis of information received; evaluate adequacy and quality of information.

• Inventory and order departmental supplies.

• Forward approved files to credentials Committee for review and approval.

• Pursue additional information independently, if necessary, for effective and comprehensive peer review decision-making.

• Immediately report to Director any problems noted with applicants' credentials as identified by principles involved in the information collection process.

• Primary responsibility for performing the mandated queries for practitioners in the credentialing process (initial and reappointments) with the National Practitioner Data Bank.

• Provide informational emails/mailings to facility departments information updates regarding approved credentialing actions.

• Maintain close communication and develop working relationships with the Centralized Verification Office, department enrollment specialists, medical staff officers, department chairmen and committee chairmen to ensure expeditious flow of recommendations for timely credentialing through the medical staff committee and Board review and approval process.

• Adhere to all policies and procedures regarding mandated queries and reporting mechanisms and monitors, on an on-going basis, the financial account with the data bank to ensure compliance and accuracy.

• Develop and maintain working relationships with chiefs, chairman, nursing staff, ancillary departments, etc. to proactively provide information regarding practitioner privileges or scope of practice and credentialing actions.

• Inform CVO of incorrect data entry and/or missing psv.

Associate's or B.S. degree in Business or Healthcare Administration is preferred; however, 3 years' experience may be substituted for a degree. Direct experience in Medical Staff Services preferred.

Licensure, Certifications, and Clearances:

CPMSM (Certified Professional Medical Services Management) or Certified Provider Credentialing Specialist (CPCS) Certification by the National Association for Medical Staff Services preferred.

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran