Job Abstract

The Credentialing Specialist is responsible for maintaining the quality and reliability of the collection and verification of practitioner applicants professional qualifications. The Credentialing Specialist completes initial and ongoing quality audits while providing constructive feedback. Additionally, the Credentialing Specialist is responsible for data analysis, action plan development and assisting in the establishment and achievement of business objectives in affiliation with all Keck Medicine of USC entities and clients.

Essential Duties:

• Responsible for the audit of the Credentialing processes. Audits 100% of credentialing and re-credentialing files and data entered into the Credentialing Database, of all Keck Medicine of USC entities and clients processed by the USC Office of Integrated Credentialing.
• Conduct audits to verify compliance with established business processes and that an effective system of internal controls is in place. Audit and monitor data, systems, and processes to ensure compliance with relevant accreditation and regulatory standards and internal policies and procedures.
• Assist in development and implementation of corrective action plans.
• Conduct mock audits and to assist in development of corrective action plans to address any identified issues
• Assist in the development of processes and procedures to verify credentialing elements such as education, training, board certification, work history, licensure, and certifications.
• Ensure business processes are performing within desired standards. Evaluates that applications are properly verified and uploaded into the online credentialing database system.
• Works with Manager or Director of the entity to prepare credentialing and re-credentialing files for accreditation surveys, mock surveys, pre-delegation and delegation surveys.
• Returns audited files showing any oversight to the relevant credentialing coordinator who originally prepared the file, for the purposes of data correction, education and coaching.
• Provides audit reports and conducts analysis including trend identification, and opportunities for improvement in order to provide individual and department level performance improvement plans. Ensure data is accurate, consistent, complete, and valid according to established standards.
• Demonstrates leadership skills and sets an example of personal performance which encourages excellence in integrity.
• Communicates clearly and concisely using strong decision making skills.
• Adheres to established guidelines as defined by Entity/Department policies.
• Maintains current knowledge of computers, systems, and applications that impact operations of Credentialing.
• Keeps current with TJC, DNV, NCQA, CMS, AAAHC and other applicable state and federal Credentialing regulations and guidelines.
• Maintains current knowledge of Credentialing and auditing industry trends.
• Independently make decisions regarding whether information meets OIC, TJC, NCQA, DNV, Title 22, and CMS and relevant bylaws/Credentialing Plan requirements related to content, completeness and timeliness.
• Ensures maximum confidentiality, accuracy, security, and appropriate access of all data and records, and provides maximum protection from discoverability of all information.
• Performs other duties as assigned.

 
Required Qualifications:

• Bachelor's degree in related field

• Combination of experience/education may substitute for minimum education requirement

• 3-5 years 3-5 years’ experience as a credentialing professional

• Ability to plan own schedule, set priorities and work independently in accomplishing work assignments on time.
• Knowledge of Joint Commission, DNV, AAHC, and NCQA standards, Title 22, and CMS regulations pertaining to the organized medical staff, required
• Knowledge of medical staff principles, practices, quality assessment, performance improvement functions, and legal concepts related to the organized medical staff, required
• Effective analytical and critical thinking verbal and written communication skills.
• Proficiency in use of MD-Staff, related applications/internal systems to collect information necessary to complete principal accountabilities.

Preferred Qualifications:

•  Certified Professional in Medical Services Management (NAMSS) Valid CPMSM or CPCS certification by the National Association of Medical Staff Services strongly preferred

Required Licenses/Certifications:

• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

USC is an equal opportunity, affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC will consider for employment all qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring ordinance. We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu.  Inquiries will be treated as confidential to the extent permitted by law.

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