Credentialing Specialist
: Job Details :

About NYC Health + Hospitals

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Under general supervision, with some latitude for independent judgement and initiative, assists and acts in a confidential capacity to health care setting and system leadership in matters directly involving personnel, labor relations, risk management, quality and safety, and compliance.

Utilize a centralized secure database to gather and house confidential data to facilitate a vetting process that ensures compliance with hiring and quality of care standards. Data gathered includes, but is not limited to licensure, controlled substance prescription certification, education and training, specialty board certification, background checks and medical malpractice history. Perform sanction queries related to practitioners history for fraud, illegal dispensing and distribution of controlled substances, and patient abuse or neglect.

Liaise, work closely with and assist labor relations, office of legal affairs, human resources, risk management, compliance, healthcare governance, quality and safety, and Epic/EMR security departments, who rely on information gathered and vetted during the medical staff and allied health professionals appointment, reappointment and privileging process, to fulfill their respective responsibilities.

In an evolved network of healthcare facilities with fully integrated systems that inform decision making, the information gathered and vetted by the credentialing professional serves as the source of truth for confidential provider information.

General tasks and responsibilities will include one or more of the following:

• Maintain confidential and sensitive information with discretion
• Responsible for all aspects of provider credentialing and re-credentialing which includes, but not limited to:
• Primary Source Verification: Completes primary source verification with centralized verification accounts for new and existing providers to ensure due diligence
• Querying of the National Practitioners Databank (NPDB) to check for medical malpractice and adverse actions taken against a provider
• Access national databases to check for sanctions or other disciplinary actions taken against a provider, such as OIG, OMIG, OPMC, OFAC, SAM, SSDM
• Gathering and verification of education, training and peer reference information
• Verification of employment history
• License Renewals: Manage and track provider licenses and notify provider prior to expiration Credentialing Standards: maintain consistent database processes that comply with The Joint Commission Standards, Centers for Medicare & Medicaid Services (CMS) Standards, New York State Medical Regulations, National Committee for Quality Assurance (NCQA) Standards, and
• internal governing documents such as Facility Bylaws, and Centralized Credentialing Policy and Procedures
• Database records management: Ongoing monitoring and management of assigned provider credentialing profiles, which includes but is not limited to:
• Investigating and validating malpractice and adverse information obtained
• Ensuring licensure and competency is current and meets regulatory standards
• Data quality/audit management
• Utilize database status/alert, report functions and other software tools to keep provider records up to date
• Maintain database links to scanned documentation
• Participate in department meetings and periodic training sessions
• Facilitate the centralized Governing Body approval process
• Manage verification requests from external medical organizations seeking hospital affiliation and malpractice coverage information for providers within our healthcare system
• Conduct/Manage/Maintain the Disaster Privileges process for internal/external providers during large scale emergencies or pandemic situations
• Facilitate OPPE/FPPE practitioner s performance evaluation process
• Facilitate the Medical Staff Member Corrective Action, Hearing and Appeals Process
• Take minutes at Medical Executive Committee (MEC) and or Credentialing Committee (CC) where confidential labor matters may be discussed which affect the appointment, reappointment, or privileging of a provider
• Generate credentialing reports to facilitate clinical initiatives within our healthcare system
• Liaise with H+H corporate and affiliate human resources for creation and management of PeopleSoft non-employee (CWR) provider accounts
• Provide technical support, guidance and maintain records of providers taking competency related courses such as Moderate Sedation, Deep Sedation, and MED-IQ (a risk management required course)
• Back-up Coverage: provide temporary credentialing back-up coverage for other members of the credentialing group

Minimum Qualifications

1. A Baccalaureate Degree from an accredited college or university in Public Health, Public Administration, Business Administration, Social Work, Psychology or Rehabilitation Counseling, and three years of full-time experience in medically oriented health care and medical support systems environment, two years of which included experience in an administrative or supervisory capacity in such occupations as physical, occupational, inhalation, speech and audiology therapy or as Medical/Laboratory Technologist, Microbiologist (various specialties), Chemist (biochemist), Radiation and X-Ray Technician or three years of responsible level experience in business management systems or general administration including two years in a supervisory or administrative capacity.

2. A Masters Degree from an accredited college or university in the disciplines listed in (1), and two years of full-time experience as listed in (1), plus one year experience in an administrative or supervisory capacity in occupations as listed in (1); or,

3. A satisfactory equivalent combination of training, education and experience.

Note: Certification or licensure may be required.

Department Preferences

• Working knowledge of credentialing systems

KNOWLEDGEABLE IN:

• Credentialing Application System
• Intellicred
• MDStaff