DescriptionSHIFT: No Weekends
HCA has been recognized as a World’s Most Admired Company in the Health Care Medical Facilities Industry by Fortune Magazine. The Ambulatory Surgery Division of HCA operates and jointly owns with physicians 130+ surgery centers across the United States. We are currently in search of additional members to join our team!
A few of the benefits we provide you:
GENERAL SUMMARY OF DUTIES: Contributes to the company’s mission and vision by supporting and coordinating credentialing activity for a defined market or market(s) of the Ambulatory Surgery Division (ASD). The MMSC handles the coordination of the credentialing program activities in conjunction with the ASD management team and in accordance with credentialing initiatives. Serves as a primary liaison between facility and Centralizing Processing Center (CPC) on processes related to initial appointment, re-appointment, and clinical privileging.
OPERATIONAL DUTIES INCLUDE BUT ARE NOT LIMITED TO:
All duties are applied in accordance with the facility processes, as appropriate.
1. Credentialing Administration
· Develop facility credentialing policies in accordance with accreditation/regulatory standards, HCA policies, and medical staff bylaws.
· Facilitate medical staff meetings (develop agendas, maintain meeting minutes, coordinate follow-up) as determined by the Medical Director, facility Administrator, or VP Operations.
· Coordinate practitioner impairment and/or MEC Ad Hoc committee along with support functions for continued monitoring.
· Coordinate other facility committees as indicated (e.g., partnerships, governing body, MEC, Quality).
· Manage correspondence between facility and individual medical staff members, as requested.
· Provide support functions to medical staff in performance of their duties.
· Prepares credentialing reports for medical staff leaders, committees, and the governing body upon which to make credentialing decisions.
· Develop, maintain, and distribute governance documents (i.e. bylaws, rules & regulations, policies) and implement annual review process.
· Serve as the primary liaison between the facility and the CPC.
· Manage all facility non-privileged provider processes in accordance with Ethics & Compliance Policy CSG.QS.002.
· Coordinate the collection and handling of medical staff fees in accordance with Ethics & Compliance Policy TRE.001.
· Update AdvantX MIS provider dictionary to be consistent with provider data in Cactus.
· Participate in planning for future medical staff recruitment.
· Maintains and distributes medical staff notices of meetings and activities.
2. Medical Staff Education
· Facilitate orientation for new Medical Executive committee members and governing body.
· Educates administrators and other center leadership on the CPC and Market Credentialing operations, privileging (including temporary and disaster privileging), HCIRs, and non-privileged practitioner credentialing.
3. Accreditation and Regulatory Compliance Relative to Credentialing, Privileging and peer review activities and functions:
· Serve as the facility’s subject matter expert regarding accreditation and regulatory requirements.
· Notifies the CPC and corporate teams of any upcoming or ongoing surveys.
· Coordinates accreditation, regulatory, and any internal surveys.
· Respond to any reviews accreditation and regulatory compliance deficiencies by developing and implementing corrective action plans, in conjunction with the Risk Manager.
4. Facility-based Credentialing Tasks
· Facilitate requests for RFC/application in accordance with CPC-01.
· Apply the credentials evaluation process uniformly to all RFC/applications and R-RFC/re-applications to ensure compliance with internal credentialing procedures.
· Process each RFC/application and R-RFC/re-application received from the CPC that has a yellow flag or a red flag and handles requests for additional privileges or new clinical privileges in accordance with CPC and MSS policies.
· Verify applicant identity in accordance with MSS.
· Forward any updated information received from providers/provider office to the CPC in a timely manner.
· Compile and analyze any available internal data and information for an assessment of qualifications and competencies for each R-RFC/re-application.
§ Compile internal data on provider’s volume
§ Compile internal information related to focused or ongoing professional practice evaluations (FPPE/OPPE), performance improvement, utilization patterns, peer review, or performance information, as assigned.
· Facilitate review, assessment, and authenticated documentation for an evaluation of each application and request for clinical privileges by the Medical Director, as required.
· Facilitate review, assessment and recommendations for each application and request for clinical privileges by the Medical Director and the Medical Executive Committee.
· Utilize “paper-lite” procedures to facilitate medical staff reviews by maximizing use of iObserver functionality in Cactus.
· Summarize and prepare credentialing information, including flagged concerns, for the board’s review and decisions.
· Actively manage provider’s expiring credentials utilizing Document Direct and in accordance with CPC and MSS policies.
· Update the Cactus system to reflect all board actions on a provider’s RFC, R-RFC, including resignations, terminations, LOAs, denials, terminations, or withdrawals in accordance with CPC and MSS policies.
· Manage and archive files according to HCA and facility procedures and accreditation/regulatory standards.
· Facilitate development of eligibility criteria for each clinical privilege.
· Facilitate the review of requests for clinical privileges using the approved eligibility criteria.
· Assess the applicability and appropriateness of clinical privileges for each specialty through periodic review.
· Maintain all up-to date-privilege content within the Visual Cactus system.
· Coordinate access by authorized facility staff to credentialing information as needed through iPrivileges or iPharmacy portal.
· Facilitate any required regulatory agency reporting of adverse actions taken against a provider’s medical staff membership or clinical privileges, as directed by facility leaders.
Performance Improvement/Peer Review
· Coordinate with the facility administrator or designee to facilitate focused professional practice evaluation (FPPE), and any related evaluation at the conclusion of FPPE or a period of provisional status.
· Coordinate with the facility administrator or designee to facilitate focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE).
· Coordinate with facility leadership in the conduct of internal and external peer reviews, as applicable.
· Coordinate with facility administrator or designee the completion of a summary of FPPE, OPPE, and peer review results (e.g. performance profiles) for evaluation by medical staff leaders as part of the R-RFC process and/or ongoing.
· In collaboration with the CPC, identify critical Market Credentialing performance benchmarks, measure performance, and take action to improve when performance is not as desired or expected.
6. Risk Management
· Coordinate with the Medical Director, Administrator and/or Risk Manager to review and evaluate an applicant’s claims history and NPDB or other reports regarding final settlements.
· Ensure timely and proper notification of the Medical Director, Administrator, and/or Risk Manager regarding possible malpractice or other liability concerns.
· Coordinate all medical staff disciplinary actions (e.g., ad hoc investigations).
· Facilitate due process in accordance with the facility’s fair hearing and appeals policy as well as legal and regulatory requirements.
· Facilitate leadership review of occurrence reports, patient complaints, close call data, SPAE reports, and other risk management information.
7. Information Management
· Develop and maintain a policy regarding the management, access to, and distribution of credentialing, privileging, and peer review information, in accordance with confidentiality requirements and record retention policies.
· Respond to external requests for information in accordance with policy.
Working under minimal direct supervision, the incumbent must demonstrate broad-based education (typically be obtained through a minimum of baccalaureate degree in a healthcare-related field) and/or equivalent level of experience that would typically be obtained in a healthcare related field.
Lead Position: Detailed working knowledge of the health care and credentialing industry, including medical-legal issues and laws, regulatory standards as related to credentialing, privileging and peer review, and other national standard
CERTIFICATE/LICENSE: CPCS and/or CPMSM Credentialing Certification required within first 12-months of employment.
We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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