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Credentialing Specialist (On-Call)

Location: Portland, Oregon;

Job ID : 3761516

Description

Under the general supervision of the Quality Resource Management Manager, Credentials, facilitates responsive, timely, accurate practitioner credentialing and provider assessment. Establishes and maintains confidential electronic and paper practitioner credential and quality files; establishes and maintains confidential electronic and paper provider assessment files. Identifies issues, pursues responses, and alerts Credentials Committee peers. Supports Credentials Committee and Provider Assessment Committee activities and documentation. Complies with KPNW Credentialing and Recredentialing policies and procedures; maintains compliance with all internal and external regulatory, certifying, and licensing bodies. Assures confidentiality and protection from discovery of credentialing and quality information.



Essential Responsibilities:
- File Preparation
- As a member of an integrated team, open and process practitioner credential, quality, provider assessment files in compliance with KPNW Credentialing and Recredentialing Policies and Procedures and QRM desk procedures. Communicate effectively with NWP and KFHP to obtain human resources and provider contract information as inputs to the credentialing and assessment processes. Mail credentialing application packets to applicants and follow-up, as needed. Investigate record of previous KPNW credentialing. Assure paper file in standardized order. Maintain electronic file record accurately, timely, with agreed formats for style, case, and professional language. Assess need for delineation of privileges; facilitate applicant and chief to achieve accurate completion of delineations. Assure complete, rapid and service-oriented initial practitioner credentialing, privileging, and provider assessment within constraints of due-diligence credentialing practices and KPNW Policies and Procedures. Audit files prior to presentation to assure completion and compliance. Issue status reports to NWP and KFH/P on progress and potential credential date. Assure complete, accurate, timely, service-oriented reappointment and reassessment within constraints of sound credentialing practices and KPNW Policies and Procedures.
- KPNW Credentials Committee and Provider Assessment Committee
- Prepare credential, assessment, and quality paper and electronic files for chief of service, Committee peer reviewer, and Committee meeting. Identify and flag issues of concern, work with chiefs and peers to pursue information. Prepare lists, reports, documents, agendas for meetings. Prompt chairs and presenters. Track open issues, follow-up on action items. Record meetings accurately, discreetly, timely and in professional minute-style. Distribute minutes confidentially and maintain survey-ready. Assure tracking, follow-through, stamping and closure of paper and electronic files. Report to Executive Committees and Boards of Directors accurately and timely.
- KPNW Credentials Committee and Provider Assessment Committee
- Prepare credential, assessment, and quality paper and electronic files for chief of service, Committee peer reviewer, and Committee meeting. Identify and flag issues of concern, work with chiefs and peers to pursue information. Prepare lists, reports, documents, agendas for meetings. Prompt chairs and presenters. Track open issues, follow-up on action items. Record meetings accurately, discreetly, timely and in professional minute-style. Distribute minutes confidentially and maintain survey-ready. Assure tracking, follow-through, stamping and closure of paper and electronic files. Report to Executive Committees and Boards of Directors accurately and timely.
- Audits and Surveys
- Maintain documentation and files survey-ready. Prepare KPNW for Internal and external audits and surveys. Meet with auditors and accreditors, respond to questions, facilitate file reviews. Know accreditation standards; achieve and maintain accreditation status. Perform/participate in KPNW audits of delegated entities and delegate-s audits of KPNW. Audit files and minutes, write reports and responses to audits. Present audit results and recommendations to Credentials Committee. Monitor and assess compliance with Credentials MOUs, identify opportunities for improvement, and ensure adequate follow-up is received as requested.
- Policies, Procedures, Forms
- Identify need for, write, flow diagram and maintain regional Credentialing and Recredentialing Policies and Procedures, desk procedures, and credentialing/organizational assessment forms that meet the standards of state and federal legislation and accrediting body standards. At least annually review and update. Link policies, procedures, forms and practices in seamless flow. Coordinate with bylaws, Medical Directors Quality Committee standards, internal and external customers. Maintain and utilize as standard operating procedures and to direct processing of special situations. In-service other departments/practitioners affected.
- Customer Service
- Support internal and external customers created by credentials delegation agreements. Act as NWP -office manager- facilitating document flow for KPNW practitioners. Act as -Credentials Verification Organization- and/or -Primary Admitting Facility- in relationships with delegates: provide reappointment packets to plan hospitals in accordance with MOU; pursue documents; generate and distribute rosters; provide copies of licenses, insurance, malpractice claims, CMEs. Communicate accurately, diplomatically-within procedures related to confidentiality and protection of peer reviewed material-with previous and current affiliations and medical boards across the country. Communicate with internal and external customers responsively to strengthen and maintain working relationships and delegation agreements.
- Delegation
- Assess potential to delegate credentialing, assessment, or any component thereof. Apply KPNW Policies and Procedures and accreditation standards to potential situation, arrive at decision, make recommendation to NWP, KFHP, Contracts Departments. Enter delegation information into paper and electronic files. Facilitate win-win relationships with delegates and potential delegates.
- Orientation
- Orient new practitioners, staff from input and output departments, chiefs of service, Quality assurance representatives, Committee peer reviewers, plan hospital partners, service managers, and committee secretaries to the practitioner credentialing and provider assessment processes. Train, educate, elicit support, and cooperation.
- Performance Reports
- Audit and track work ongoing. Complete accurate and timely reports to be used for reporting purposes to Northwest Permanente, the Regional Operations Group and Boards of Directors summarizing monthly activity. Participate in Healthcare Data and Information (HEDIS) data-gathering and inputting.
- Perform other duties as requested.
Qualifications: Basic Qualifications:
Experience
- Minimum one (1) year of experience in medical staff credentialing and privileging including assembly of quality files.
Education
- Minimum of associate degree or certificate of training in credentialing; NAMSS CPMSM or CPCS certificate, or equivalent experience and willingness to pursue certification at earliest opportunity
- High school diploma or GED.
License, Certification, Registration
- NAMSS CPCS, or CPMSM maintained or willingness to obtain at earliest possible time and to maintain.


Additional Requirements:
- Familiar with NCQA, JCAHO standards, state/federal requirements regarding credentialing and organizational assessment.
- Familiar with National Practitioner Data Bank/Healthcare Integrity and Protection Data Bank requirements, reporting processes and timelines.
- Excellent verbal and written communication and human relations skills.
- Proven ability to establish and maintain effective working relationships with various levels of management, co-workers, subordinates, interregional employees, medical staff, medical/professional boards, and representatives from outside services/agencies.
- Demonstrated ability to manage various projects simultaneously and accurately in order to meet multiple deadlines.
- Demonstrated computer proficiency, especially with office automation and credentialing software.
- Demonstrated attention to detail.
- Ability to work in a fast-paced environment involving frequent changes in processes and procedures.
- Documented excellent attendance record.


Preferred Qualifications:
- Minimum two (2) years of experience credentialing.
- Previous experience preparing for and participating in JCAHO, NCQA or other external surveys.
- BA/BS degree or equivalent education and work experience.
-NAMSS CPCS or CPMSM certification maintained or willingness to pursue certification as at earliest possible time and maintain.


- Working knowledge of NCQA and JCAHO medical staff, credentialing and organizational assessment standards.
- Working knowledge and experience of office automation system, Windows, Excel, Access and credentialing software.
- Customer service oriented verbal and written communication skills.
- Excellent problem solving skills.





Primary Location:Oregon,Portland,Kaiser Permanente Building 500 NE Multnomah St.

Scheduled Hours (1-40):1

Shift:Day

Working Days:Mon-Fri

Schedule:Call-in/On-Call

Job Type:Standard

Employee Status:Regular

Employee Group:SEIU - Local 49

Job Level:Individual Contributor

Job:Healthcare / Hospital Operations

Public Department Name:QRM

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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