Note: The job is a remote job and is open to candidates in USA. UMass Memorial Health is a health system providing patient care, academic excellence, and medical research in Central Massachusetts. The Credentialing Specialist gathers, verifies, and maintains documentation used to assess the qualifications and clinical competence of medical staff, prepares appointment and reappointment applications, and supports credentialing processes with practitioners, departments, committees, and affiliate hospitals.
Responsibilities
• Performs a variety of duties to obtain, compile, gather, check, arrange, verify and assemble all information and documentation/credentials required for determining the qualifications and clinical competence of medical staff (physicians, dentists, psychologists, podiatrists, dentists, oral surgeons, nurses in expanded roles, physician assistants, social workers, etc.) Prepares documentation for review by the Director, Department Chairs/Division Chiefs and Chief Medical Officer, Residency Program Director, Graduate Medical Education leadership, and by respective committees as applicable
• Performs a variety of duties to prepare applications for practitioners who are applying for privileges at UMass Memorial Medical Center and at any member or affiliate hospitals. Prepares documentation in compliance with shared credentialing agreements established system wide and with other affiliates. Assists applicants in applying for out-of-state licenses as may be required for their duties with UMass Memorial Medical Group
• Prepares and distributes applications for appointment and reappointment, using electronic applications whenever feasible. Ensures appropriate authorizations for release of application have been received. Enters, scans and logs all data in Echo
• Reviews incoming applications for appointment and reappointment to ensure completeness, check for adverse or questionable information, discrepancies, and that appropriate supporting documentation has been received
• Processes queries (electronic or written) for verification of education, training, practice history, malpractice history, licensure, specialty boards, criminal history, sanction and discipline history
• Processes queries to National Practitioner Data Bank, American Medical Association Physician Master file, Federation of State Medical Boards, Educational Commission for Foreign Medical Graduates, and American Board of Medical Specialties or equivalent, Office of the Inspector General, Excluded Parties Listing Service, and Criminal Background check. Reviews results for any sanctions, claims, questionable references or information, discipline, criminal history, gaps in education or training, and discrepancies with information provided by applicant
• Prepares findings for review and recommendation by chief/chair, Credentials Committee, Medical Staff Executive Committee, and Patient Care Assessment Committee
• Prepares applications for UMass Memorial Medical Center practitioners who are seeking appointment/reappointment at member/affiliate hospitals. Works with practitioner and member/affiliate hospital in collection of data, ensuring completeness of information, electronic submission of application data to member/affiliate hospital. Track application through member/affiliate process through completion
• Reports all adverse and questionable findings to Director. Obtains additional information as may be requested
• Works with clinical department administrators, designees, chief and chairs, and clinical practitioners on issues related to credentialing
• Responds to requests from assigned clinical practitioners in providing documentation, answering credentials related questions, serving as a resource in directing practitioners to information on licensure, specialty boards, life support certification, CME opportunities. Providers reminder notices to clinical practitioners regarding documents scheduled for renewal (licensure, prescriptive authority, etc.)
• Works extensively in Echo credentialing database. Maintains provider information, including demographic information, specific clinical privileges approved, confidential data, licensures, certification, education, training, practice, history, status. Enters, edits, scans, runs reports and letters
• Works with extremely sensitive and confidential information
• Complies with established departmental policies, procedures and objectives
• Attends variety of meetings, conferences, seminars as required or directed
• Demonstrates use of Quality Improvement in daily operations
• Complies with all health and safety regulations and requirements
• Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors
• Maintains, regular, reliable, and predictable attendance
• Performs other similar and related duties as required or directed
Skills
• 1. High School diploma or equivalency required
• 2. National certification as Experience with Microsoft Word and data entry skills required
• 1. Familiar with legal standards of Credentialing required. Ability to deal with extremely sensitive and confidential information in a professional manner
• Work is considered sedentary. Position requires work indoors in a normal office environment
• 1. Associate's degree or certification in business or healthcare related discipline preferred
• 2. CPMSM(Certified Professional Medical Services Management) or CPCS (Certified Provider Credentialing Specialist), or willingness to pursue certification is required
Benefits
• This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.
• Primarily remote work arrangement
Company Overview
• UMass Memorial Health is the health and wellness partner of the people of Central Massachusetts. It was founded in 1999, and is headquartered in Worcester, Massachusetts, USA, with a workforce of 10001+ employees. Its website is https://www.ummhealth.org.