Medical Staff Credentialing Manager jobs in Temple, TX

BASIC FUNCTION

The Credentialing and Privileging Coordinator oversees the process of credentialing clinical staff joining HealthPoint, a Federally Qualified Health Center (FQHC), and ensuring their privileges are aligned with their qualifications. Clinical Staff includes licensed practitioners (for example, Physician, Dentist, Physican Assistant, Nurse Practitioner), other licensed or certified practitioners (for example, Registered Nurse, Licensed Practical Nurse, Registered Dietician, Certified Medical Assistant), and other clinical staff providing services on behalf of HealthPoint (for example, Medical Assistants or Community Health Workers that do not require licensure or certification).

PRIMARY RESPONSIBILITIES AND DUTIES

• Current documentation of basic life support training.

• Ensures initial and recurring review, every two years, of all clinical staff.

• 
  Ensures the following for privileging clinical staff, as applicable:

• Verification of fitness for duty, immunization, and communicable diseases status;

• For initial privileging, verification of current clinical competencies via training, education, and as available, reference reviews;

• For renewal of privileges, verification of current clinical competence via peer review or other comparable methods (for example, supervisory performance reviews; and

• Maintain records of all clinical staff’s denial, modification, or removal of privileges based on assessments of clinical competence and/or fitness for duties

• Maintain updated credentialing and privileging files and databases, ensuring completeness and accuracy of information.

• 
  HealthPoint Contract Providers Documentation, whether through formal, written referral agreements, with other provider organizations that provide services within scope of HealthPoint’s project, ensure that such providers are:

• Licensed, certified, or registered as verified through a credentialing process, in accordance with applicable federal, state, and local laws; and

• Competent and fit to perform the contracted or referred services, as assessed through a privileging process.

• 
  Policy Development and Implementation

• Provide input in developing and implementing credentialing policies and procedures in alignment with accreditations and regulatory requirements.

• Continuously review and update credentialing policies and procedures in conjunction with the Compliance Department to reflect changes in regulations and best practices.

• 
  Collaboration and Communication

• Collaborate with internal stakeholders, including medical staff, human resources, compliance, and legal departments, to ensure alignment with compliance with the credentialing requirements.

• Serve as a liaison between providers and external agencies, such as insurance companies and government entities, regarding credentialing matters.

• Communicate credentialing decisions and updates to providers in a timely and professional manner.

• 
  Quality Assurance and Compliance

• Conduct regular auditson credentialing files and processes to ensure compliance with regulatory standards.

• Participate in internal and external audits related to credentialing and privileging.

• Identify and address areas for improvement in the credentialing and privileging processes to enhance efficiency and effectiveness.

• 
  Training and Education

• Provide training and education to providers and staff on credentialing requirements, processes, and best practices.

• Offer guidance and support to provide throughout the credentialing process, addressing any questions or concerns.

• 
  Data Management and Reporting

• Generate reports and maintain accurate records related to provider credentialing and privileging activities.

• Analyze data trends to identify opportunities for process improvement and performance enhancement.

• 
  Risk Management

• Identify and mitigate risk associated with credentialing and privileging processes to ensure patient safety and quality of care.

• Implement measures to address any potential legal or regulatory issues related to provider credentialing.

• 
  Professional Development

• Stay abreast of changes in healthcare regulations, accreditation standards, and industry trends related to credentialing and privileging.

• participate in professional development activities, such as conferences and workshops, to enhance knowledge and skills in credentialing practices.

• 
  Performs other duties as assigned.

• Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.)

Mission: To provide evidence-based healthcare utilizing a patient empowered team approach resulting in individual wellness.

Vision: Best place for patients to receive care. Best place for providers to practice medicine. Best place for employees to work.

Values: Integrity, Respect, Empathy, Ethics, Excellence, Diversity, Safety, Professional.