Under the supervision of the Director Medical/House Staff Services Department, the Credentialing Specialist processes credentialing and re-credentialing applications of health care providers appointed through the Medical Board and Governing Body, reviews applications, prepares verification letters and maintains database.
Duties of a Credentialing Specialist may include the following but are not limited to:
Process the credentialing and re-credentialing applications of physicians and allied health providers (psychologists, podiatrists, speech and language therapists, physician assistants, audiologists, optometrists, nurse midwives, nurse practitioners, and nurse anesthetists) in accordance with the medical staff policies, bylaws rules and regulations, Department of Health, JCAHO and NCQA regulations.
Process appointments including: Input application/addendum data into Visual Cactus; Analyze application for gaps in experience, education or training and communicate with applicant for information as needed; Conduct primary source verifications on all applications; Solicit, collect and review peer reference information; Review specific criteria for procedures and determine if candidate meets criteria; Communicate with practitioner, department representatives, other affiliations and professionals to collect and verify all information necessary to complete; Prepare appointment package for review by division chief, credentials committee, chief of service, MEC, and medical board, which includes alerting respective committees to "red flags" based on knowledge of staff, federal and local regulatory bodies; When necessary, prepare timeline report to indicate gaps, unverifiable periods, etc.; Review file for completeness after review by credentials committee, division chief and chief of service; Prepare appointment letters and appointment package for practitioner; Create data file of privileges in Cacti Privileges; Input and activate practitioner information in SMS; Enter practitioner in PeopleSoft database, input badge information; Distribute hard copies of privileges; Review credential committee minutes to determine that all necessary information, as per JCAHO, DOH and NCQA standards, is included; Maintain constant communication with School of Medicine Department liaisons.
Process reappointments including: Create pre-populated applications for all practitioners via Visual Cactus program; Track submission and send out late notices; Update data revisions; Conduct primary source verifications; Collaborate with various hospital departments to obtain practitioner specific information for review by credentials committee, chief of service, etc. ; Communicate with practitioner, department representatives, other affiliations and professionals to collect and verify all information necessary to complete application; Preparation of reappointment file for review by division chief, credentials committee, chief of service, MEC, and medical board, which includes alerting respective committees to "red flags" based on knowledge of staff, federal and local regulatory bodies; Review file for completeness after review by credentials committee, division chief, and chief of service; Prepare reappointment letters; Update data file of privileges in Cacti Privileges; Distribute hard copy of privileges.
In connection with evaluating applicants for appointment and reappointment, as per section 2805K of the health law, incumbent is responsible for requesting information and responding to requests from other affiliations regarding malpractice and misconduct history. Information received is recorded in database after being extracted from documents.
Acts as a resource with department administrative coordinators regarding physician's status and what is needed for appointment/reappointment.
Process terminations including: Archive file; Inactivate in several databases; Remove privilege information from other offices; Notify Medical Records; Notify IT.
Assign and maintain computer numbers.
Maintain updated information for each practitioner by running monthly expiration reports (license, DEA, Infection Control, malpractice insurance, health, boards, life support); Send expiration notifications to all practitioners, track receipt, update database and take appropriate action for non-compliance based on Medical Board policies.
Input and production of reports on computerized network database.
Coordinates administrative privilege process with department administrators/coordinators.
Corresponds with other healthcare institutions regarding status of physician privileges, membership standing, etc. and queries insurance companies regarding malpractice claims.
Produce malpractice claims history reports for practitioners for managed care applications.
Assists with Medical Board meetings by preparing agendas and attachments for minutes and distribution of same.
Assists with house staff orientation each June.
Responsible for utilizing Cactus House and New Innovations databases to respond to inquiries.
Supervise clerical staff as indicated.
Other duties as assigned.
Associates Degree, and relevant experience to include medical credentialing . In lieu of degree, four years administrative experience, which includes 3 years of Credentialing experience.
Computer skills that specifically include mail merges in Microsoft Word and exporting files in Microsoft Excel.
Ability to work in a very busy office with constant interruptions and detail oriented.
Knowledge of JC and NCQA regulations as it pertains to medical staff credentialing.
Experience using Visual Cactus. CPCS or CPMSM Certification.
Special Notes : Resume/CV and cover letter should be included with the online application.
Posting Overview : This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions maybe subject to changes in pass days and shifts as necessary.
This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Prior to start date, the selected candidate must meet the following requirements:
Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
Complete electronic reference check with a minimum of three (3) professional references.
Successfully complete a 5 panel drug screen*
Successfully complete a Background Check investigation.
Provide a copy of any required New York State license(s)/certificate(s).
Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
*The hiring department will be responsible for any fee incurred for examination .
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.
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Official Job Title: TH Staff Assistant I
Job Field: Administrative & Professional (non-Clinical)
Primary Location: US-NY-Stony Brook
Department/Hiring Area: Medical Staff Administration-Stony Brook University Hospital
Schedule: Full-time Shift: Day Shift Shift Hours: 8:30 - 5:00 Pass Days: Sat, Sun
Posting Start Date: Apr 20, 2021
Posting End Date: Jul 20, 2021, 3:59:00 AM
Salary: Commensurate with experience
Salary Grade: SL2
Internal Number: 2101219
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