and Responsibilities Responsible for understanding, analyzing, and understanding and applying Medical Staff Bylaws, State, and Federal and Regulatory Agency requirements, accreditation compliance and other critical matters that may affect the healthcare environment as it relates to the credentialing process and Medical Staff related functions. Coordinates credentialing activities; including data entry and physician database maintenance; credentialing processes, expirable and other duties that support provider onboarding activities.
Serves as effective liaison between practitioner, hospital and Centralized Verification Office (CVO) throughout the credentialing process. Ability to analyze facility‐specific Medical Staff Bylaws and other policy requirements to assure compliance. Initiates and coordinates the collection of primary source information for credentialing purposes.
Verifies, compiles, manages and maintains confidential research required for credentialing of initial appointment and reappointment applicants. Processes applications according to established legal, State and Federal agencies, State licensing board, regulatory and facility standards. Coordinates, tracks, and monitors flow of information to ensure the timely processing and notification of applicants in accordance with the guidelines and policies established.
Conducts thorough analysis of all primary source documentation received for assessment of qualifications/competencies. Assures appropriate education and training including procedural documentation has been provided to support clinical privileges requested. Identifies any potential quality of care issues, behavioral problems, and/or other issues escalating as necessary.
Summarizes and prepares credentialing information, including information about flagged concerns, for review and decisions. Applies the credentials evaluation process uniformly to all initial appointment and reappointment applications to ensure compliance with CHI St. Luke’s Health credentialing policies, procedures and applicable Medical Staff Bylaws.
Compiles information regarding CME credits and other requirements in accordance with state licensing requirements and Division policy. Facilitates medical staff leadership review and evaluation of documentation in each application. Serves as a primary point of contact for practitioners during appointment and reappointment process.
Must be available to guide practitioners through the process and clearly communicate requirements. Communicates questions and concerns regarding application documentation with leaders in a clear, concise and factual manner. Maintains an accurate, secure and current database of physician and advanced practitioner/allied health professional information.
Follows data entry policy. Mentors less experienced colleagues. Actively identifies, participates in developing and implementing best practices.
Conducts audits to identify opportunities for improvement, providing feedback to colleagues and supervisor. Reviews and develops delineation of privilege forms analyzing multi‐specialty criteria for consistency. Tracks monitoring/proctoring documentation as necessary for the granting of special or new privileges.
Supports the medical staff organization as assigned including meeting agendas, minutes and meeting attendance which may include but is not limited to the *Credentials Committee, Medical Executive Committee and other high‐level, confidential meetings. Supports medical staff leaders as assigned. Serves as a liaison, trainer and mentor to hospital and CVO medical staff department team members.
Collaborates with other hospital and division departments as appropriate to facilitate credentialing, onboarding and other tasks as assigned. Develop and enhance relationships with the medical staff and their office staff through contacts, needs assessments, distribution of information, problem identification and resolution. Appropriately escalates concerns regarding credentialing documents and/or timeliness of the verification process.
Communicates with the CVO and other facilities appropriately and in a timely manner according to policy. Maintains confidentiality. Supports system and division standardization efforts.
Actively identifies, participates in developing and implementing best practices. Performs other duties as assigned in an effective, competent and timely manner. Job Requirements Education & Experience Associates Other upon hire Preferred and PCS and/or CPMSM upon hire or 10 years of experience in the medical staff services profession required or 4-6 years or five (5) years’ experience and Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) certification Required Where You'll Work St.
Luke's Health - Patients Medical Center provides inpatient and outpatient medical and surgical services to residents of Pasadena, Deer Park, La Porte, Baytown, and Clear Lake. The facility includes 53 medical/surgical beds, eight ICU beds and three endoscopy rooms, and offers a range of primary and specialized services—wound care, general surgery, gastroenterology, occupational health, heart and vascular, women’s services, diagnostic imaging, outpatient rehab services, and sleep disorders.