Cherokee Indian Hospital Authority is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).  To read more about this, view the EEO is the Law poster and this EEO is the Law Poster Supplement

Start Over with Job Search

Returning Applicant?  Login Now

Credentialing Clerk
Job Code:2022-01-002
Department:Executive & Administration
FT/PT Status:Regular Full Time
Salary Minimum$19.66
Salary Midpoint$22.25
  
Position Closes:

Job Responsibilities & Qualifications:

Primary Function    

To assist in coordinating the credentialing process for healthcare providers as required by federal state and accreditation standards. Under administrative review, is responsible for initiating and coordinating the clerical, secretarial functions required in effective implementation of administrative policies and administration of Medical/Dental Staff services.

 

Is responsible for assisting with creating and maintaining credentialing records (physical files and electronic).

 

Job Description        

  • May be necessary to work when Administrative Leave is granted if patient care would be compromised.
  • Serves a Credentialing Specialist to ensure Joint Commission compliance.
  • Initial Application: Responds to the request from the Clinical Directors to ensure JCAHO compliance and/or other accrediting program (CAP), mail packets; reviews applications received for completeness, requesting additional information as needed, enter data into applicable computerized systems, verify licensure, board certification, education/training, obtain references from all previous hospital affiliations and two peers, verifying the application is complete before sending to Governing Board for approval, obtaining the appropriate signatures.
  • Reappointment applications: Systematically sending reappointment packets each month, following up on those not returned in a timely manner, reviewing applications received for completeness, requesting additional information as needed, verify licensures, board certification, obtain references from all current hospital affiliations and two peers, verifying the application is complete before sending to the Governing Board for approval, obtaining the appropriate signatures
  • Verify licensure certification education/training.
  • Maintains the credentialing computer system (PRIVplus) through data entry, performance of back-ups.
  • Assists with communication with all medical and dental providers for critical and timely management of provider scheduling, completion of performance evaluations, completion of evaluation of contracted services, and disaster call-back procedures.
  • Assists in maintaining agendas, minutes and attendance; secretarial support, research data, and send physician reminders.
  • May assist executive staff as necessary.
  • Assists Clinical Director and Chief of Medical Staff and Chief of Dental Staff in provider recruitment as necessary.
  • May be responsible for maintaining and updating spreadsheets for the medical/nursing departments.
  • Performs typing and transcription duties as required.
  • Arranges, participates in, and implements, as directed, conferences and committee meetings.
  • Serves as recording secretary to Medical Staff meetings.
  • Coordinates resident and student rotation requirements for medical residents, medical students, dental students, PA students, and FNP students. Requirements for resident/student rotations include the application process, contracting process, evaluation process, and management of support functions including daily schedule coordination and housing arrangements (if available). The application requires obtaining of a complete student application packet consisting of cover letter, curriculum vitae, CIHA volunteer application, letter of good standing from program director, and student evaluation requirements from the host institution. The Chief of Medical/Dental Staff or their designee shall pre-approve the student rotation and schedule, and then an affiliation agreement must be developed through the Contracting Officer, and the application must have final processing through Human Resources. Housing arrangements (if housing available) will also be made for medical students.
  • Serves as a backup timekeeper for Medical Staff.
  • Assists Clinical Director, Chief of Staff, and Medical Directors in the development and coordination of in-house trainings.
  • Assists with development of sign-in systems, documentation for continuing medical education credits, and other required documentation of required trainings for all credentialed members of the Medical/Dental Staff presentations involving continuing education.
  • Performs related duties as assigned.

     

    Education/Experience          

  • An Associate Degree in Business or a Health related field is required
  • Minimum of three years’ experience in a professional office setting.
  • The equivalent combination of education, related experience and training may be considered in lieu of formal education.
  • Position will require 1 year to become proficient in most phases of the job.
  • Will be expected to work towards obtaining Certified Provider Credentialing Specialist (CPCS) certification.

 

Job Knowledge         

  • Incumbent is responsible for facility compliance with Joint Commission standards as related to Medical Staff accreditation. Must have thorough understanding and participate in the review process by the Joint Commission Standards for the Accreditation of Hospitals with regards to medical staff credentialing. Possess ability to carry-out these complex standards in independent manner as they require constant attention to detail. Must have ability to work with all staff and contract physicians to ensure that standards are met.
  • Must have knowledge of the policies, procedures, and operational guidelines of the CIHA. Must have knowledge of general office procedures. Must have knowledge of CIHA personnel policies. Demonstrated dependability, maturity, and judgment in performance of duties. Knowledge of modern secretarial and general office principles, practices, techniques, and Federal and State reporting requirements. Ability to use word-processing software on desk-top professional computers (e.g. Microsoft Word, Excel, Outlook, and Access), operate printers, copier, and fax machines as well as other office equipment as required.
  • Must have knowledge of the purchasing procedures and know how to use GEMS and Healthcare Insights for departmental budget management.
  • For time keeping purposes must have knowledge of Attendance Enterprise.
  • Ability to understand and execute complex oral or written instructions and to apply extensive and obscure guidelines to a wide variety of work situations.
  • Ability to establish and maintain effective working relationships with other employees, public and private officials, contractors, and the general public.
  • Must have the ability to accurately deal with difficult dictation.
  • Must have the ability to write correspondence, compile data, analyze data and make concise, accurate reports and recommendations. Must have the ability to organize work, deal effectively with the public, communicate effectively both verbally and in writing, follow instructions and work as a member of a group or independently. Knowledge of Cherokee culture and tribal operations is required.
  • Ability to take directions and carry out orders effectively with minimal or no supervision.
  • Must be able to adapt in stressful situations when dealing with disgruntled patients.

 

Contact with Others

Has frequent contact with Executive Directors, program directors and personnel, general public, and Governing Board. Contact involves dealing with superiors, employees and general public, contractors, facility and maintenance vendors, Federal, State, Tribal agents, CIHA and IHS regarding explanations, discussions, procedures and obtaining approval. Contact requires a high degree of tact, courtesy, and business etiquette to maintain positive working relationships.

 

Confidential Data    

Works with and/or has access to highly confidential Division files, memos, contract proposals, personnel and payroll information of which would be considered confidential and should not be disclosed. Must adhere to all CIHA confidentiality policies and procedures, as well as the Privacy Act of 1974 and HIPAA.

 

Mental /Visual/Physical Effort       

Close concentration and attention to detail are required while performing most duties of the job. Is subject to frequent interruptions, both by phone and in person, which require varied responses with each contact. The duties of this job routinely require standing, walking, and sitting, kneeling, crouching, reaching, seeing, speaking, and hearing. May occasionally move more than 10 pounds.

 

Environment 

Works in normal business office environment with occasional visits to program sites while performing job duties. May involve contacts with patients in both well and illness status.

 

Responsibility for Accuracy

Data entry requires a high degree of accuracy. Work effects the accuracy and reliability of further processes, time schedules, staff time, and public relations. Most errors can be detected with proofing procedures. Errors may also have adverse effects on internal and outside relationships.

 

Follows well define procedures and guidelines in job duties with minimal or no supervision. Must communicate and respond appropriately to various situations. Judgment and initiative are required to maintain accuracy, efficiency, and to prioritize work and meet deadlines.

 

Failure to perform medical staff credentialing properly could jeopardize Joint Commission accreditation for the Cherokee Hospital and have serious adverse consequences in terms if third party collections and public perception. Data entry requires a high degree of accuracy.

 

Customer Service     

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.