Med Staff Svc Coordinator FT HYBRID

Advocate Health; Oak Brook (IL); On-site; USD 90,000 - 110,000; Full time

Job summary

Advocate Health is seeking a Credentialing and Privilege Specialist to coordinate initial credentialing and ongoing reappointments for medical staff. The role analyzes practitioner data to support approval bodies and ensures compliance with accrediting standards, state/federal law, and hospital bylaws.

The position requires collaboration with quality teams and administrative leadership, onboarding new practitioners, and maintaining accurate privilege entries and EMR access.

Qualifications

• 3 years of experience in a health care setting that includes privileging and credentialing processes.
• Strong knowledge of regulatory requirements and accreditation standards (DNV, TJC, CMS, HFAP, EMTALA, HQIA, NCQA, URAC).
• Excellent communication and organizational skills; ability to interact with physicians and health care professionals.

Responsibilities

• Coordinate credentialing and privileging at initial appointment and biennial reappointment.
• Analyze data to support credentialing decisions for Medical Staff leaders and committees.
• Ensure compliance with accreditation standards, state and federal law, and Medical Staff bylaws.
• Onboard and orient new practitioners; activate privileges and ensure EHR access.
• Prepare monthly reports for Governing Bodies on credentialing and privileging.

Skills

Credentialing

Privileging

Regulatory compliance

Policy knowledge

MS Office

Education

High School Graduate

Tools

MS Office

EMR access

Job description

Major Responsibilities:

• Coordinates and facilitates medical staff and advanced practice professional credentialing and privileging at the time of initial appointment and biennial reappointment. Critically analyzes data to create informed recommendations for credentialing, re-credentialing, and privileging for Medical Staff leaders and committees, ensuring adherence to accreditation standards, state and federal law, and Medical Staff bylaws. Verify and analyze practitioner-specific data obtained during the credentialing and privileging for approval bodies. Identify, review and report practitioner performance data, complaints, sanctions, adverse actions, and quality of care issues in order to facilitate analysis and evaluation of current/ongoing practitioner competency by approval bodies, including Credentials Committee, Medical Executive Committee, and Governing Bodies.
• Ensures continuous knowledge of and adherence to regulatory requirements, accreditation standards, Medical Staff Bylaws and Medical Staff and organizational policies and procedures. Ensures all practices and procedures are in accordance with Det Norske Veritas (DNV), The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Healthcare Facilities Accreditation Program (HFAP), Emergency Medical Treatment and Labor Act (EMTALA), Healthcare Quality Improvement Act (HQIA), National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), State law, Medical Staff bylaws and hospital and system-wide policies. Responsible for coordination of and survey preparation for all Medical Staff matters for regulatory surveys and audits. Reviews and implements new actions related to federal and state rulings and accrediting body standards pertaining to the functions of the Medical Staff.
• Develops, establishes, and enforces Medical Staff bylaws, rules and regulations, and policies that govern the activities of the Medical Staff and coordinates the activities of the self-governing organized Medical Staff.
• Coordinates and manages the onboarding and orientation of newly appointed practitioners to the Medical Staff, including development, implementation, and maintenance of the regulatory and legally required education. Ensures accurate entry of privileges, arranges authorization processes to allow practitioners electronic medical record access, makes all appropriate entries into applicable systems to activate the practitioner and ensure practitioner inclusion in rosters, directories, and reports.
• Responsible for creating monthly reports for the Governing Bodies on credentialing and privileging, and other Medical Staff actions and matters.
• Collaborates with the quality management department to develop and distribute quality data for the Focused Professional Practice Evaluation (FPPE) process and the Ongoing Professional Practice Evaluation (OPPE) according to regulatory requirements. Researches and recommends FPPE criteria and ensures that all new applicants undergo FPPE within established timeframes, following up with proctors and/or reviewers as necessary. Collaborates with Department Chiefs and Section Chairs to review OPPE data.
• Serves as a liaison between the medical staff, administration, ancillary departments and patients.
• Establish and maintain systems to facilitate committee meetings and communication for the Medical Staff governance structure, adhering to Robert’s Rules of Order, including with Medical Staff leaders and members, departments and sections, and hospital administration.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 3 years of experience in a health care setting that includes experiences in privileging and credentialing processes.

Knowledge, Skills & Abilities Required:

• Maintain upward communication with leadership regarding development within areas of assigned responsibilities and perform special projects as required or requested.
• Ability to represent the department effectively with supporting teams.
• Demonstrate problem solving, critical thinking, and process analysis skills to support teams.
• Possess willingness to learn and develop understanding of configuration best practices.
• Willingness to escal ... issues that may impact team productivity or confusion on priorities.
• Strong knowledge of medical terminology.
• Excellent communication, organizational and problem solving skills.
• Must have proven track record of effective interactions with physicians and other health care professionals.
• Proficient in the use of Microsoft Office (Excel, Access, PowerPoint and Word) or similar products.
• Ability to work effectively with minimal supervision and manage multiple priorities.

Physical Requirements and Working Conditions:

• Must be able to sit for extended periods of time.
• Must be able to occasionally lift up to 10 lbs.
• Must be able to use hands with fine manipulation when using keyboard.
• Must hold a valid driver's license and be willing to travel between Metro Region Hospitals as needed.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the duties of the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.