Presbyterian Healthcare Services

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CREDENTIALING SPECIALIST

at Presbyterian Healthcare Services

Posted: 5/14/2020
Job Reference #: 13826
Keywords: medical

Job Description

Requisition ID
2020-13826
Category
Provider Services
Default: Location : City
Albuquerque
Location : Name
Rev Hugh Cooper Admin Center
Default: Location : State/Province (Full Name)
New Mexico

Overview

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

Summary:
Conducts thorough background investigation on physicians and other providers applying for affiliation with PHS -Albuquerque and regional facilities. This includes reviewing applications for completeness, conducting primary source verification of licensure, education, post-graduate clinical training, board certification, disciplinary actions and other professional sanctions, malpractice history, and peer assessment of current competence. Identifies issues that require additional investigation and/or follow-up. Responsible for collecting and processing reappointments of Medical Staff members and ensuring they are completed within specified time periods. Processes requests for updated privileges, status changes. Maintains a variety of tickler systems to ensure that processing is timely and meets state and federal regulatory requirements and accreditation standards as they apply to Credentialing. Maintains accurate data in the credentialing database which is accessed by multiple business units within the organization.

Responsibilities

*Analyze practitioner applications and/or requests to ensure that required documentation/information has been submitted in order to initiate the primary source verification processes

*Conducts primary source verification of applicants' education, licensure, professional work history, medical malpractice history for the purpose of determining competency and eligibility to be awarded membership and/or privileges

*Prepares processed files for review by appropriate members of medical staff leadership, including identification of information that may require additional investigation

*Utilizes appropriate tracking tools for the purpose of ensuring timely completion of applications

*Collects/analyzes data from various sources to include with initial and/or reappointment applications. Such data includes but is not limited to focused professional practice evaluations, ongoing professional practice evaluations, and privileging eligibility criteria

*Process other credentialing requests, as assigned, in accordance with established policies and procedures

*Responsible for on-boarding and/or orientation of new Medical Staff members, according to established policies and procedures

Qualifications

High School Diploma. One to three years experience in hospital medical staff or managed care credentialing preferred. Certification or eligibility for certification as a Current certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.

Updated: 7.18.19

Education:
Essential:
* High School Diploma or GED

Competencies and skills:
Nonessential:
* SKILL-Ability to effectively interact with customers to understand their needs and explain data
* SKILL-Microsoft Office
* SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
* SKILL-Written communication

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

BENEFITS END

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