Credentialing Specialist/Medical Group Coordinator
- Grand Rapids, MI
- Mary Free Bed Rehabilitation Hospital
- Medical Group Admin
- Full-Time - Days - 8a-5p
- Posted: December 3, 2019
We have the great privilege of helping patients and families re-build their lives. It’s extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients “Ask for Mary,” they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.
Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.
Restoring hope and freedom through rehabilitation.
Maintains regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. Create and carry out various credentialing processes in relation to physicians and other hospital staff professionals within Mary Free Bed Rehabilitation Hospital, Medical Group, and Orthotics and Prosthetics. Ensure all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
Essential Job Responsibilities:
- Assist with the onboarding process of medical staff to hospital, medical group, and orthotics and prosthetics group. Including, but not limited to:
- Assist in submitting necessary applications online for new applicants and temporary privileges.
- Review and prepare files for the Medical Executive Committee and Board approval if needed.
- Give finalized documents to Chief Medical Officer for approval.
- Send communication upon approval/denial to necessary parties.
- Complete quality data on providers every 6 months regarding Focused Professional Performance Evaluations (FPPE) and Ongoing Professional Performance Evaluations (OPPE).
- Process all applications and reappointment paperwork, checking for full completeness and accuracy for professionals to practice within hospital as well as participate with contracted insurance companies.
- Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database; maintain practitioner paper and electronic data files for practitioners; use the CAQH system to submit practitioner data as required by some client health plans to credential individual practitioners.
- Constantly collect and process verification and accreditation information and constantly maintain and update accurate databases for both practitioners and facility.
- Maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.
- Coordinates the Medical Staff Office in conjunction.
- Processes updates to current Medical Staff files (insurance updates, license updates, etc.)
- Processes FPPE’s and OPPE’s in accordance with Medical Staff policies.
- Processes requests for references from other hospitals and insurance companies.
- Assists in the preparation of the Medical Executive Committee meeting materials.
- Assists in other Medical Staff functions as requested.
- Assists the in smooth operations of the Medical Group administration office and support
- Maintain awareness with high degree of confidentiality, on hospital and corporate issues involving the Medical Group
- Prepare agendas, agenda materials and takes minutes for the all Medical Group/Physician monthly meetings and others as assigned by the Director of the Medical Group. Arrange for meeting rooms, meals, refreshments if necessary and any audio-visual equipment required.
- Gather and prepare data and complete special reports and surveys as required by various agencies and institutions with which the department is associated.
- Works in collaboration with outside agencies and institutions in the initiation and development of department projects, relationships and associations.
- Oversee department policies and procedure maintenance. Maintains current versions on InsideMFB
- Helps maintain Medical Group employee records:
- Maintains/tracks 90 day and annual performance review completion of all staff.
- Maintains educational activity including BLS, ACLS, and PALS certificates.
- Assists and acts as a back up to the Residency Coordinator
- Coordinates the Residency Program in conjunction with the Program Director and Residency Coordinator including:
- Updates schedule changes and coverage as necessary
- Processes requests and inquiries for information/material about the residency program
- Helps coordinate Medical Student Rotations
- Updates handouts about rotations and scheduling for all residents
- Coordinates meetings for Program Director(s) and/or Department Chairman
- Compiles and reports Continuing Medical Education (CME) credits for attending physicians to be reported to the Office of Continuing Education
- Insures compliance with all Accreditation Council for Graduate Medical Education (ACGME) requirements for residence
- Perform other duties as required.
Essential Job Qualifications (Knowledge, Education, and Training Requirements):
- Two-year associate’s degree in Business, Finance, Health Care Administration/or a minimum of two years of experience in both professional and hospital based credentialing.
- Possess high knowledge base of health care quality guidelines developed by the National Committee for Quality Assurance.
- Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel.
- Significant relevant work experience in a high-level office management position with a minimum of 3-5-year experience. Competent language and grammar skills with the ability to compose, edit and proof letters, memos, minutes and other correspondence.
- Proficient computer skills in multiple applications (MS Word, Excel, and Office Outlook) are essential.
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements.
- Familiarity with medical billing and claims payment system requirements as related to practitioner enrollment.
- Physical Demands: Able to exert up to 10 pounds of force occasionally (up to 1/3 of the time); to lift, carry, push, pull, up to 10 pounds occasionally; to sit for the majority of the time, but may involve brief periods of time involving walking or standing; to use keyboard frequently (1/3 to 2/3 of the time)