Specialist, Medical Staff Credential

Job Summary Under the general supervision of the Quality Resource Management Manager, Credentials, facilitates responsive, timely, accurate practitioner credentialing and provider assessment. Establishes and maintains confidential electronic practitioner credential and quality files; establishes and maintains confidential electronic provider assessment files. Identifies issues, pursues responses, and alerts Credentials Committee peers.

Supports Credentials Committee and Provider Assessment Committee activities and documentation. Complies with KPNW Credentialing and Recredentialing policies and procedures; maintains compliance with all internal and external regulatory, certifying, and licensing bodies. Assures confidentiality and protection from discovery of credentialing and quality information.

Essential Responsibilities File Preparation: As a member of an integrated team, open and process practitioner credential, quality, provider assessment files in compliance with KPNW Credentialing and Recredentialing Policies and Procedures and QRM desk procedures. Communicate effectively with NWP and KFHP to obtain human resources and provider contract information as inputs to the credentialing and assessment processes. Email credentialing application packets to applicants and follow-up, as needed.

Investigate record of previous KPNW credentialing. Assure electronic file in standardized order. Maintain electronic file record accurately, timely, with agreed formats for style, case, and professional language.

Assess need for delineation of privileges; facilitate applicant and chief to achieve accurate completion of delineations. Facilitate proctoring, also known as Focused Professional Practice Evaluation (FPPE) through completion. Assure complete, rapid and service-oriented initial practitioner credentialing, privileging, and provider assessment within constraints of due-diligence credentialing practices and KPNW Policies and Procedures.

Audit files prior to presentation to assure completion and compliance. Issue status reports to NWP and KFH/P on progress and potential credential date. Assure complete, accurate, timely, service-oriented reappointment and reassessment within constraints of sound credentialing practices and KPNW Policies and Procedures.

Audits and Surveys: Maintain documentation and files survey-ready. Prepare KPNW for Internal and external audits and surveys. Meet with auditors and accreditors, respond to questions, facilitate file reviews.

Know accreditation standards; achieve and maintain accreditation status. Perform/participate in KPNW audits of delegated entities and delegates audits of KPNW. Audit files and minutes, write reports and responses to audits.

Present audit results and recommendations to Credentials Committee. Monitor and assess compliance with Credentials delegation agreements, identify opportunities for improvement, and ensure adequate follow-up is received as requested. Policies, Procedures, Forms: Identify need for, write, flow diagram and maintain regional Credentialing and Recredentialing Policies and Procedures, desk procedures, and credentialing/organizational assessment forms that meet the standards of state and federal legislation and accrediting body standards.

At least annually review and update. Link policies, procedures, forms and practices in seamless flow. Coordinate with bylaws, Medical Directors Quality Committee standards, internal and external customers.

Maintain and utilize as standard operating procedures and to direct processing of special situations. In-service other departments/practitioners affected. Customer Service: Support internal and external customers created by credentials delegation agreements.

Act as NWP office manager facilitating document flow for KPNW practitioners. Act as Credentials Verification Organization and/or Primary Admitting Facility in relationships with delegates: provide reappointment packets to plan hospitals in accordance with delegation agreements; pursue documents; generate and distribute rosters; provide copies of licenses, insurance, malpractice claims, CMEs. Communicate accurately, diplomatically-within procedures related to confidentiality and protection of peer reviewed material-with previous and current affiliations and medical boards across the country.

Communicate with internal and external customers responsively to strengthen and maintain working relationships and delegation agreements. Delegation: Assess potential to delegate credentialing, assessment, or any component thereof. Apply KPNW Policies and Procedures and accreditation standards to potential situation, arrive at decision, make recommendation to NWP, KFHP, Contracts Departments.

Enter delegation information into electronic files. Facilitate win-win relationships with delegates and potential delegates. Orientation: Orient new practitioners, staff from input and output departments, chiefs of service, Quality assurance representatives, Committee peer reviewers, plan hospital partners, service managers, and committee secretaries to the practitioner credentialing and provider assessment processes.

Train, educate, elicit support, and cooperation. Performance Reports: Audit and track work ongoing. Complete accurate and timely reports to be used for reporting purposes to Northwest Permanente, the Quality Oversight Committee and Boards of Directors summarizing monthly activity.

Participate in Healthcare Data and Information (HEDIS) data-gathering and inputting. Performs other duties as requested. #J-18808-Ljbffr