CVS Credentialing Specialist 1
JOB SUMMARY
Under general supervision, responsible and accountable for all functions of the Coordinator Credentialing CVS relating to credentialing and re-credentialing of the medical staff and allied health professionals as appropriate for the Baylor Scott & White Health. Responsible for the accuracy and integrity of the credentialing database system. Functions as a Coordinator Credentialing to assure optimum performance of the department. Is knowledgeable of Joint Commission for Accreditation of Healthcare Organizations (TJC) and Center for Medicare and Medicaid Services (CMS) and other regulatory agencies as they pertain to medical staff and allied health professionals.
ESSENTIAL FUNCTIONS OF THE ROLE
Confirms correct TSCA application (as applicable) is being utilized and is accurate and complete.
Confirm receipt of appropriate privilege cards and supporting documentation for accuracy and completion (as applicable).
Assesses any required fees.
Creates checklist in credentialing software system.
Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet for online and electronic verifications.
Communicates regarding processing questions from practitioner and/or credentialing contact in addition to BSWH MSS offices and CVS leadership as required.
Sends all status and reminder communication to practitioner.
Maintains the daily licensure workload.
Researches and resends returned mail.
Maintains data integrity of the credentialing and software system according to established policies and procedures.
Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.
Performs other duties as required. Job duties are subject to changes as directed by management.
KEY SUCCESS FACTORS
Associates degree or equivalent preferred but not required (i.e. some college)
- Requires 1 -3 three years of experience in health care credentialing/ verification.
- Knowledge of Health Line System (Medical Staff Line and/or Echo) or other credentialing system preferred.
- Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.
- Advanced computer skills in word processing, spread sheets and databases.
Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff and allied health professionals in compliance with the medical staff bylaws, medical staff policies and procedures, AHP policies, JCAHO, CMS standards and other regulatory agencies. Processes confidential medical staff and allied health professional files requests for, but not limited to:
- Processes and maintains confidential medical staff and allied health professional data files requests for, but not limited to:
- New applications
- Reappointment applications
- Staff category changes
- Resignations/ Retirement
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Associate's or 2 years of work experience above the minimum qualification
- EXPERIENCE - 1 Year of Experience
Under general supervision, responsible and accountable for all functions of the Coordinator Credentialing CVS relating to credentialing and re-credentialing of the medical staff and allied health professionals as appropriate for the Baylor Scott & White Health. Responsible for the accuracy and integrity of the credentialing database system. Functions as a Coordinator Credentialing to assure optimum performance of the department. Is knowledgeable of Joint Commission for Accreditation of Healthcare Organizations (TJC) and Center for Medicare and Medicaid Services (CMS) and other regulatory agencies as they pertain to medical staff and allied health professionals.
ESSENTIAL FUNCTIONS OF THE ROLE
Confirms correct TSCA application (as applicable) is being utilized and is accurate and complete.
Confirm receipt of appropriate privilege cards and supporting documentation for accuracy and completion (as applicable).
Assesses any required fees.
Creates checklist in credentialing software system.
Obtains primary source information through utilization of verification software/ databases as well as approved verification sites via the Internet for online and electronic verifications.
Communicates regarding processing questions from practitioner and/or credentialing contact in addition to BSWH MSS offices and CVS leadership as required.
Sends all status and reminder communication to practitioner.
Maintains the daily licensure workload.
Researches and resends returned mail.
Maintains data integrity of the credentialing and software system according to established policies and procedures.
Maintains a working knowledge of the medical staff bylaws, medical staff rules and regulations, allied health professional policies, as well as other policies and procedures pertaining to credentialing, etc.
Performs other duties as required. Job duties are subject to changes as directed by management.
KEY SUCCESS FACTORS
Associates degree or equivalent preferred but not required (i.e. some college)
- Requires 1 -3 three years of experience in health care credentialing/ verification.
- Knowledge of Health Line System (Medical Staff Line and/or Echo) or other credentialing system preferred.
- Knowledge of basic anatomy and physiology, medical terminology and functions of medical staff services.
- Advanced computer skills in word processing, spread sheets and databases.
Coordinates the credentialing, re-credentialing and clinical privileging process of new applications and reappointment applications to the medical staff and allied health professionals in compliance with the medical staff bylaws, medical staff policies and procedures, AHP policies, JCAHO, CMS standards and other regulatory agencies. Processes confidential medical staff and allied health professional files requests for, but not limited to:
- Processes and maintains confidential medical staff and allied health professional data files requests for, but not limited to:
- New applications
- Reappointment applications
- Staff category changes
- Resignations/ Retirement
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Associate's or 2 years of work experience above the minimum qualification
- EXPERIENCE - 1 Year of Experience
